Reducing Harm Supporting Recovery 2017 2025

Reducing Harm,
Supporting Recovery
A health-led response to drug
and alcohol use in Ireland 2017-2025
EN
R ERY
V
D
CO
IL
CH
RE
FRIE
G
FA
ITY
LIN
ND
LY
UN
A
E
I
H
S
M
M
CO
Contents
Foreword by An Taoiseach 3
Foreword by Minister of State for Health Promotion and the

National Drugs Strategy 4
Acknowledgements by Chair of Steering Committee 6
CHAPTER 1 – Introduction 7
Context 8
CHAPTER 2 – Vision, Values and Goals 16
Vision 16
Values 16
Goals 17
CHAPTER 3 – Goal 1: Promote and protect health and wellbeing 19
Objective 1.1: Promote healthier lifestyles within society 21
Objective 1.2: Prevent use of drugs and alcohol at a young age 22
Objective 1.3: Develop harm reduction interventions targeting at risk groups 28
Performance indicators related to Goal 1 32
CHAPTER 4 – Goal 2: Minimise the harms caused by the use and misuse
of substances and promote rehabilitation and recovery 33
Objective 2.1: To attain better health and social outcomes for people
who experience harm from substance misuse and meet their recovery
and rehabilitation needs 33
Objective 2.2: Reduce harm amongst high risk drug users 49
Performance Indicators related to Goal 2 53
CHAPTER 5 – Goal 3: Address the harms of drug markets and reduce

access to drugs for harmful use 54
Objective 3.1: Provide a comprehensive and responsive misuse of drugs

control framework which ensures the proper control, management and
regulation of the supply of drugs 54
Objective 3.2: Implement effective law enforcement and supply

reduction strategies and actions to prevent, disrupt or otherwise
reduce the availability of illicit drugs 59
Objective 3.3: Develop effective monitoring and responses to evolving

trends, public health threats and the emergence of new drug markets 61
Performance indicators related to Goal 3 62
Reducing Harm, Supporting Recovery A health-led response to drug and alcohol use in Ireland 2017-2025 1
CHAPTER 6 – Goal 4: Support participation of individuals, families and communities 63
Objective 4.1: Strengthen the resilience of communities and build their

capacity to respond 63
Objective 4.2: Enable participation of both users of services and their families 66
CHAPTER 7 – Goal 5: Develop sound and comprehensive evidence-informed

policies and actions 69
Objective 5.1. Support high quality monitoring, evaluation and research

to ensure evidence-informed policies and practice 69
CHAPTER 8 – Strengthening the performance of the strategy 73
CHAPTER 9 – Conclusion 81
CHAPTER 10 – Strategic action plan for the period 2017-2020 82
APPENDIX 1 – Membership of the Steering Committee on the

National Drugs Strategy 98
APPENDIX 2 – List of relevant inter-connected strategies

and policies 99
Glossary of Terms 100
References 102
2 Reducing Harm, Supporting Recovery A health-led response to drug and alcohol use in Ireland 2017-2025
Foreword
For the ideal of a Republic of Opportunity to be meaningful, it must apply to all.
Treating substance abuse and drug addiction as a public health issue, rather than
as a criminal justice issue, helps individuals, helps families, and helps communities.
It reduces crime because it rebuilds lives. So it helps all of us.
Ireland has a problem with substance misuse. Rates of drug use in Ireland have risen
significantly over the past decade, with the greatest increases among younger people.
Many Irish people engage in harmful drinking patterns and alcohol has become a major
drugs issue. The rise in the number of families affected by the loss of a loved one due
to drug use is a serious cause for concern. These issues highlight the need to intervene
effectively to reduce the harms associated with substance misuse, and combat the
underlying reasons for the demand for drugs.
Reducing Harm, Supporting Recovery represents a whole-of-government response

to the problem of drug and alcohol use in Ireland. The strategy draws upon a range
of government policy frameworks in order to reduce the risk factors for substance
misuse, such as social or educational disadvantage, family circumstances or poor
health. It recognises the importance of supporting the participation of communities
in key decision making structures, so that their experience and knowledge informs the
development of solutions to solve problems related to substance misuse in their areas.
Reducing Harm, Supporting Recovery emphasises a health-led response to drug

and alcohol use in Ireland, based on providing person-centred services that promote
rehabilitation and recovery. A person-centred approach means giving people a say
in their own treatment and supporting them to play a role in their own recovery. This
approach also requires services to work together so that people do not fall through
the cracks, as they navigate the different services required to meet their specific needs.
The strategy recognises the need for a balanced approach, which involves reducing
the demand for drugs and reducing access to illegal drugs. It outlines the key law
enforcement strategies to protect the public from the harms of illegal drug markets
and the monitoring arrangements required to meet Ireland’s international obligations
at EU and UN level.
I welcome the initiative of the Minister for Health, Simon Harris TD and the Minister
of State for Health Promotion and the National Drugs Strategy, Catherine Byrne TD,
for bringing forward this strategy to respond to the problem of drug and alcohol use
in Ireland.
This government will work to build a Republic of Opportunity that means something
in people’s lives, especially those who have not had many opportunities in the past.
I hope the new strategy will make a real difference and encourage everyone to put
their own health and wellbeing first, so that we can realise the vision of this strategy
for a healthier and safer Ireland.
Leo Varadkar, T.D.

Taoiseach
Foreword
As Minister I firmly believe in a health-led and person-centred approach to our
drug and alcohol problem. Following my recent appointment as Minister of State
for Health Promotion and the National Drugs Strategy, my ministerial remit has
been extended to include the Healthy Ireland Framework. Alcohol and drug policy
are now core elements of my portfolio in line with the central vision of Reducing
Harm, Supporting Recovery, a health-led response to drug and alcohol use in
Ireland.
Through my involvement in the public consultation for this strategy, I heard how
drug and alcohol use affects individuals, families and communities across the
country and what key issues should be addressed in the new response. The need
for a more compassionate approach to drug use was raised repeatedly in the
course of the consultation, with many people calling for drug use to be treated as a
health issue, rather than a criminal issue. I was also struck by the fact that so many
contributors to the public consultation believed that drug and alcohol education
needs to start in primary school and continue through secondary school.
The importance of high quality drug and alcohol education is recognised in the
strategy, which recommends that substance use education should be provided
alongside wellbeing programmes, information campaigns and other preventative
measures. Together these initiatives, if effectively delivered, give young people
the tools to make informed choices about substance use and encourage them to
embrace positive lifestyle changes, which can improve their health and wellbeing.
The independent expert panel, that conducted a review of our previous drug
strategy, characterised alcohol as the elephant in the room, in considering Ireland’s
response to the drug problem. This strategy acknowledges that alcohol, while legal,
is a drug like any other and prioritises an integrated public health approach to drug
and alcohol use. I hope this approach will be strengthened in the coming years. The
strategy contains many measures which should contribute towards a reduction
in alcohol-related harm and delay early alcohol use among young people. The
Public Health (Alcohol) Bill which is currently being progressed, contains legislative
provisions to reduce alcohol consumption in Ireland, and this will also be a key step
forward.
A lot of work has been done over the past two decades to develop comprehensive
drug and alcohol services that are capable of dealing with all substances. There
is still considerable scope for improvement. That’s why this strategy contains
a series of actions which aim to reduce waiting times, provide more equity of
access to services around the country and remove potential barriers to accessing
treatment by those with complex needs. The introduction of a pilot supervised
injecting facility in Dublin’s city centre and the establishment of a working group to
examine alternative approaches to the possession of controlled drugs for personal
use, are among a number of initiatives contained within the strategy to promote a
harm reducing and rehabilitative approach to drug use.
The strategy also highlights the importance of continuing support for law
enforcement in an effort to combat organised crime groups which traffic illegal
drugs into Ireland. The importance of monitoring changing illegal drug markets,
against the background of national, EU and broader international experience and
best practice, is also emphasised in the strategy. Drug-related intimidation is a
further area of concern addressed in the strategy which I believe requires special
attention, as it presents a real threat to public safety in communities.
Finally, I would like to thank the many people who have been involved in the
development of this strategy and have been working intensively on this process
since December 2015. I would particularly like to thank John Carr, for his able
stewardship of the Steering Committee on the National Drugs Strategy. I would
like to pay a special tribute to the service users and recovery champions who
addressed the public consultation events in Dublin, Limerick, Cork, Galway,
Kilkenny and Carrick-on-Shannon. They demonstrated that with the support and
help of their families, communities and the staff of the drug and alcohol services,
people can rebuild their lives after addiction and that recovery is an attainable goal.
Catherine Byrne, T.D.

Minister of State for Health Promotion and the National Drugs Strategy
Acknowledgements
As independent chair of the National Drugs Strategy Steering Committee, I was
keen to ensure that the Committee would provide a forum for all perspectives to
be heard so that the new strategy would benefit from the collective expertise and
experience of those around the table. To maintain the integrity and independence
of the process, I also chaired the Focus Groups that were convened to advise the
Steering Committee on actions to address gaps in the response.
I would like to thank everyone who contributed to the success of the project,
most notably;
l the members of the Steering Committee, whose dedication and
commitment, enabled us to develop the policy and related actions in
“Reducing Harm, Supporting Recovery”, on the basis of consensus;
l the members of the Focus Groups on Supply Reduction, Education and
Prevention, Continuum of Care and Evidence and Best Practice for their
contribution to the Strategic Action Plan;
l Paul Griffith, Scientific Director and Nicola Singleton, Scientific Analyst at
the European Monitoring Centre on Drugs and Drug Addiction and Professor
Sir John Strang, Director, National Addictions Centre, Kings College London
who participated on the panel which carried out a Rapid Expert Review of
the current drugs strategy;
l all who participated in the public consultation and RPS Project
Communications, who compiled the report;
l The Centre for Public Health at Liverpool John Moores University for their
assistance in developing the evidence base;
l the Health Research Board, especially Brian Galvin, for his sterling support
during the drafting phase; and
l Susan Scally and her team from Drugs Policy Unit, for their professionalism,
commitment and support, in particular, Dairearca Ní Néill, Jane-Ann
O’Connell, John Kelly and Mary T Hally, secretary to the Steering Committee.
It is true to say that a significant effort has gone into the development of
“Reducing Harm, Supporting Recovery”. This has involved a wide range of sectors,
stakeholders and interests working together. If we harness this energy and
revitalise the partnership approach which characterised previous drug strategies,
I have no doubt that we can deliver on the ambitious goals of this strategy and
achieve better outcomes for those whose lives have been impacted by drug and
alcohol use.
John Carr
Chair of the National Drugs Strategy Steering Committee
CHAPTER 1 – Introduction
Reducing Harm, Supporting Recovery sets out the Government’s strategy to address the
harm caused by substance misuse in our society up to 2025. It identifies a set of key actions
to be delivered between 2017 and 2020, and provides an opportunity for the development of
further actions from 2021 to 2025 to address needs that may emerge later on in the lifetime
of the strategy.
The strategy aims to provide an integrated public health approach to substance misuse.
Substance misuse means the harmful or hazardous use of psychoactive substances, including
alcohol, illegal drugs and the abuse of prescription medicines. The public consultation which
informed the strategy highlighted changing attitudes towards people who use drugs, with calls
for drug use to be treated first and foremost as a health issue.
Ireland’s previous national drugs strategies covered the period from 2001 to 2008 1 and 2009
to 2016 2 respectively. Both strategies aimed to reduce the harm caused by the misuse of
drugs, through a concerted focus on supply reduction, prevention, treatment, rehabilitation
and research. The new strategy will also advocate a harm reduction approach, but will place
a greater emphasis on supporting a health-led response to drug and alcohol use in Ireland.
Partnership between the statutory, community and voluntary sectors was a major factor in the
success of previous strategies, and will continue to be the cornerstone of the new strategy. Drug
and Alcohol Task Forces (DATFs) will play a key role in coordinating interagency action at local
level and supporting evidence-based approaches to problem substance use, including alcohol
and illegal drugs. The new strategy will provide a way of measuring the collective response to
the drug problem, through a performance measurement framework.
The Healthy Ireland Framework 3 provides an over-arching context for the development of this
new strategy and its actions will contribute towards improving the health, wellbeing and safety
of the population of Ireland in the coming years. The new strategy will foster a person-centred
approach to those who develop drug or alcohol-related problems, while underlining the need
for a whole-of-Government response to the socio-economic, cultural and environmental risk
factors contributing to the causes of substance misuse.
This Chapter sets out the context for the strategy and outlines the vision for the future.
Chapter 2 describes the vision, values and goals linked to the overall strategic vision.
The five key goals set out to realise the vision are discussed in Chapters 3, 4, 5, 6 and 7. Chapter
3 outlines the work underway to promote and protect health and wellbeing related to substance
misuse, and proposes some specific actions to strengthen the response in this area. Chapter
4 describes the measures that have been undertaken to minimise the harm caused by the
use and misuse of substances and promote rehabilitation and recovery, and proposes a range
of new measures to improve health and social outcomes for people affected by substance
misuse. Chapter 5 discusses the key measures being undertaken to address the harms of drug
markets and reduce access to drugs for harmful use. Chapter 6 examines the arrangements in
place to support the participation of individuals, families and communities in the development
of solutions to respond to the drug problem and to provide safe, person-centred services.
Chapter 7 considers the evidence needed to inform the development of policy, initiatives and
interventions to address problem substance use.
Chapter 8 outlines the arrangements required to support the effective implementation of

the strategy, including the structures through which this will be done. It also describes the
performance measurement system which will be used to measure the collective response to
the drug problem. Chapter 9 sets out the key conclusions from the strategy, which will inform
the policy direction to the drug problem in future years. The strategic action plan for the period
2017-2020 is outlined in Chapter 10.
Vision
Our vision is for:
“A healthier and safer Ireland, where public health and safety is protected and the harms
caused to individuals, families and communities by substance misuse are reduced and
every person affected by substance use is empowered to improve their health and
wellbeing and quality of life”.
To realise this vision, five strategic goals have been identified:

1. Promote and protect health and wellbeing.
2. Minimise the harms caused by the use and misuse of substances and promote
rehabilitation and recovery.
3. Address the harms of drug markets and reduce access to drugs for harmful use.
4. Support participation of individuals, families and communities.
5. Develop sound and comprehensive evidence-informed policies and actions.
Context
Since the first drugs strategy was introduced in 2001 1, much has been done to improve access
to treatment and provide a wider range of services for those who develop health problems as
a result of the consumption of alcohol and other drugs. Methadone maintenance treatment has
become more widely available, particularly in inner city areas, and in those parts of the country
with higher rates of heroin use. Local and Regional Drug and Alcohol Task Forces (DATFs) have
supported the development and expansion of integrated and accessible community-based
services. This has resulted in greater access at local level to harm reduction initiatives, such as
methadone and needle exchange and other wrap-around services and supports, such as advice
and information, family support, childcare and complementary therapies.
In cooperation with family support networks, community and voluntary-led providers and peer
networks, the Health Service Executive (HSE) has provided training in the administration of
the opioid anti-dote naloxone to reduce the incidence of fatal overdoses among people who
inject drugs 4. Additional HSE funding has also resulted in an increased number of residential
addiction beds providing treatment, detoxification and aftercare services. However, it is
acknowledged that there is a need to provide wider geographic access to addiction services
and to continue to diversify the range of treatment options available to meet current and
emerging needs.
Significant law enforcement efforts have been invested in intercepting drugs destined for
the Irish market. International operations spearheaded by law enforcement agencies have
resulted in significant seizures and the disruption of organised crime networks involved in the
importation, distribution and sale of illegal drugs in this country. Recent years have also seen a
decisive response to the proliferation of headshops selling new psychoactive substances across
the country. Legislation preventing the sale of psychoactive substances in headshops has been
introduced and new controls have been put in place to remove these harmful substances from
our streets 5. However, drugs continue to be widely and easily accessible and the range of
methods by which drugs can be sourced has expanded significantly in recent years, in particular
through the internet. In tandem with this, escalating levels of violence related to the drugs trade
have had a serious impact in a number of communities.
While communities experiencing large-scale social and economic deprivation and
marginalisation continue to be disproportionately affected by drugs issues, the impact of the
drug problem has extended across the country into other cities, towns and rural areas over
the course of the last two decades. The nature of problem drug use has also changed; a wide
range of drugs are now being used, including legal drugs, illegal drugs and alcohol. The illicit
trade in prescribed medications, such as benzodiazepines and z-drugs, has created a serious
threat to public health, particularly among the population of people who are homeless and use
substances.
Substance misuse affects people from all walks of life, from different backgrounds and
communities. The 2014/15 drugs prevalence survey 6 found that one in four Irish adults (26.4%)
has tried an illegal drug at least once in their lifetime. Trends over the past decade point to
an increase in the rate of last year (an indicator of recent use) and last month (an indicator
of current use) drug use, with the greatest increases in drug use amongst younger people. In
common with other European countries, the use of cannabis is considerably higher than any
other form of drug, with 6.5% of adults using this drug in the last year. Younger people are
more likely to use cannabis than older adults. In relation to illegal drug use, cannabis is the
most commonly used drug among children in the 15-16 year age group.
A recent study indicates that the prevalence of problematic opiate use in Ireland has stabilised 7.
Based on 2014 figures, there are an estimated 18,988 opiate users in Ireland. While the overall
prevalence is stabilising, the spread of opiate use across the country is apparent, although
highest prevalence rates are still recorded in Dublin.
One of the most devastating consequences of problem drug use is drug-related poisonings
that lead to a loss of life. Data from the National Drug-Related Deaths Index (NDRDI), a national
surveillance database which records drug-related deaths (such as those due to accidental and
intentional overdose) and deaths among drug users (such as those due to Hepatitis C and HIV),
shows overdose deaths increased in Ireland from 301 in 2005 to 354 in 2014, representing an
increase of 17.6% 8.
New patterns of drug use and related harms have emerged over the past decade that need to
be considered in developing an effective response to the drug problem. These include high risk
behaviours associated with substance use, increased use of cannabis and ecstasy, particularly
amongst younger people, and a rise in cannabis-related problems that may be associated with
the increased use of more potent strains of domestically produced herbal cannabis.
Against this background, the Minister with responsibility for the National Drugs Strategy has
been tasked by Government to put a new strategy in place which would address current and
emerging challenges into the future.
Methodology
Steering Committee
On 8 December 2015, the Minister of State with responsibility for the National Drugs Strategy
established a Steering Committee to advise on the development of a new strategy and
appointed an independent chair to guide the Committee in its work. The Terms of Reference
of the Committee were as follows:
l Provide guidance and advice to assist the Minister of State in the development of a new
National Drugs Strategy from 2017 onwards;
l Develop an integrated public health approach to substance misuse, which is defined
as the harmful or hazardous use of psychoactive substances including alcohol and illicit
drugs, incorporating the relevant recommendations of other related policies including
the National Substance Misuse Strategy 9;
l Review the report of the Expert Review Team on the National Drugs Strategy 2009-
2016 10 and the evidence briefing by the Health Research Board on the drugs situation
in Ireland 11 and international best practice in responses 12;
l Review the operational effectiveness of the structures and co-ordination mechanisms
of the National Drugs Strategy, including the Drug and Alcohol Task Forces, NACDA,
NDRIC, OFD, NCC and carry out a SWOT analysis on the partnership approach;
l Examine the relevance of the existing Strategy in tackling the current nature and extent
of problem drug use in Ireland, including emerging trends and cross-cutting issues having
regard to the available research, information and data sources. This will identify any gaps
presenting and indicate how they might be addressed;
l Examine developments in drug policies and identify international best practice in dealing
with problem drug use generally, at EU and International level;
l Conduct a consultative process and draw conclusions from same;
l In light of the foregoing, consider how a new Strategy post-2016 should address problem
drug use, including the structures through which this could be done, and incorporating
performance indicators to measure the future effectiveness of the new Strategy; and
l Present Report to the Oversight Forum on Drugs for discussion and submission to
the Minister of State, who will submit the proposals for a new Strategy to the Cabinet
Committee on Social Policy and Public Service Reform for approval.
The Committee met 19 times and its membership is set out at Appendix 1.
Focus Groups
To enable engagement with statutory, community and voluntary bodies who have a role in the
delivery of the objectives of the Strategy, the Steering Committee convened four focus groups.
Each focus group was asked to give their views on the relevance of the current strategy in
responding to problem drug use in Ireland, to identify any gaps presenting, and to indicate how
they may be addressed. To ensure the independence of the process, the Chair of the Steering
Committee also chaired the focus groups. A focus group was established to examine each of
the following areas:
l Supply reduction;
l Education and Prevention;
l Continuum of care, encompassing treatment, rehabilitation and recovery; and
l Evidence and best practice.
Each focus group produced a position paper proposing measures to address gaps in the
current response to the drug problem, which were considered by the Steering Committee
and formed the basis for the strategic action plan.
Public Consultation
This strategy was informed by a public consultation which was undertaken by RPS Project
Communications, (part of the RPS group), on behalf of the Department of Health. The aim
of the public consultation was to engage with the general public, people who use services,
families, communities and organisations across society and to obtain their views on the drugs
issue in Ireland to help inform the new strategy. Specifically, the public consultation sought to
obtain views from the public on:
l the supply reduction, prevention, treatment, rehabilitation and research pillars
of the 2009-2016 National Drugs Strategy;
l the key issues that the Department of Health should consider in the development
of the new strategy;
l the roles involved in the management of the drugs issue in Ireland; and
l emerging trends about drugs misuse in Ireland.
A range of options were provided for feedback, including email, post, telephone, an online
questionnaire or through attendance at 6 regional events held in Carrick-on-Shannon, Limerick,
Cork, Dublin, Galway and Kilkenny. A separate questionnaire was developed for young people to
ensure that everyone who would be affected by the new drugs strategy had the opportunity to
inform and shape it.
Nearly 3,000 individuals and organisations from across Ireland provided feedback to the public
consultation. A breakdown by background of 2115 respondents to the on-line questionnaire
is set out in Figure 1. 835 respondents did not indicate any of the choices available and are
categorised as “unspecified”.
Figure 1: Summary of background information provided by respondents
Individual 641
Service user 65
Professional 352
On behalf of organisation 76
Carer 29
Other 117
Unspecified 835
Source: Public Consultation Report.63
The following is a summary of the key issues raised repeatedly by respondents in the language
provided via the submissions and questionnaires. The full findings are detailed in the public
consultation report, which is available at: http://health.gov.ie/
Perceptions of the National Drugs Strategy

l While 27% of those responding to the consultation questionnaire were aware that Ireland
had a drugs strategy, overall awareness was low.
l Of those who were aware, there was feedback that the strategy was broad-ranging,
comprehensive and focussed, and has ensured Ireland’s drugs issues remain on the
national agenda.
l Those who cited awareness of the Strategy felt that it was well assembled in terms of
content and is largely consistent with the drug strategies and action plans of many other
EU Member States.
l There was also feedback that the pillar structure is not integrated/co-ordinated enough.
Supply Reduction
l The need to change negative attitudes towards people who use drugs was a recurring
theme, with calls for drug misuse to be treated as a medical and health issue, rather than
a criminal issue.
l Drugs are not just a city or urban issue but are available throughout Ireland in small towns
and villages and rural areas. Drugs are also an issue across all social demographics.
l Reducing supply is only part of the problem – demand is what drives availability and the
reasons for demand need to be addressed.
l Many people who use drugs said they are subjected to debt intimidation and violence.
l Legal and illegal drugs should be reclassified based on their level of risk for real physical
and/or mental harm.
l There were calls for legalisation and/or decriminalisation of drug use.
l The potential medical benefits of cannabis were cited frequently in questionnaire
responses, with calls for cannabis to be legalised for medical use and available on
prescription for this purpose.
l There were also calls, on a lesser scale, for other addictions such as gambling, tobacco
and caffeine to be considered within the strategy.
Prevention
l Alcohol should be recognised as a major drugs issue in Ireland, particularly among
younger people and alcohol should be integral to the new strategy.
l Education should begin in primary school and many service users felt children aged 6-11
should be provided with factual information about the effects of drugs.
l More education and public awareness campaigns are needed and information should be
provided through schools, parents, communities, television, internet, social media and
mobile phone apps.
l There should be a focus on mental health as a means to address prevention.
l Calls for services for children to be improved, including safeguarding for young people
whose families/caregivers are affected by addiction.
Treatment
l Service users want a sense of choice and to have a say in their treatment options.
l Fear of legal ramifications and stigma was suggested as a barrier to seeking treatment
for illegal drug use.
l There were views in support of and against injection centres.
l Calls for more GPs to be involved in prescribing methadone, particularly outside the
Dublin area, and in promoting and encouraging detoxification.
l There were calls for Suboxone to be provided as an alternative to Methadone and for the
wider roll-out of the opioid overdose anti-dote, Naloxone.
l A belief that there are significant blocks in the system for people who have both a mental
health and addiction issue was a recurring theme.
l A lack of transport and significant travel times for those in rural communities was cited as
a significant barrier to accessing services.
l People are coping with rural isolation through the use and misuse of legal drugs such as
alcohol and prescription drugs.
l A need was identified for designated assessment centres in the community for all drugs
and alcohol use, with care-pathways to other supportive specialist services in primary
care, community services, tertiary services and residential services.
l There are no programmes aimed at the recreational drug user who may not consider
themselves addicted to drugs.
l There was feedback that a holistic approach to treatment is needed with greater inter-
agency working, communication and co-ordination.
Rehabilitation
l People should be helped to meet their goals using a case management process, and
service users should have a distinct say in their own rehabilitation.
l Families should have a role in in treatment and rehabilitation; there is a need for services
for families; and for them to be more integral to how services are developed.
l To maintain recovery requires a range of services, including housing, family support,
education, community employment (CE) programmes, free legal aid, social welfare advice
and budgeting services and support to return to employment.
l Many called for mutual aid, support networks and continued aftercare to be made more
widely available, including mutual aid, such as AA, for younger people.
Research
l A wide range of research themes were identified, including research into:
n how addictive and damaging occasional use of different substances is;
n the extent and patterns of substance use in Ireland (including rural areas);
n what substances are most misused and underlying reasons for use;
n accurate death tolls;
n “secret” behaviours, such as drinking in middle class homes; and
n the cost effectiveness of the ‘war on drugs’.
Evidence Review
The Health Research Board (HRB) commissioned the Centre for Public Health at Liverpool
John Moores University to prepare a trends analysis on the drugs situation in Ireland 11 and a
report on the most recent international evidence on responses to problem drug use 12. The
drugs situation in Ireland: an overview of trends from 2005 to 2015 11 reviews the current drug
situation in Ireland, analysing ten years of data up to the most recent data available with
respect to the five European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) key
indicators (prevalence of drug use, high risk drug use, treatment demand, drug-related deaths
and mortality and drug-related infectious diseases) as well as drug-related crime and supply. In
addition to presentation of national trends, this report includes additional evidence looking at
trends in data relating to specific sub-populations including people who inject drugs, prisoners,
homeless individuals, sex workers and the Travelling community.
The effectiveness of interventions related to the use of illicit drugs: prevention, harm reduction,
treatment and recovery. A ‘review of reviews’ 12 examines evidence on effective delivery of
interventions in the areas of prevention, harm reduction, treatment and recovery relating to illicit
drug use with the overarching aim of reducing the use of illicit drugs and related harms, and
increasing successful recovery and rehabilitation following drug misuse.
The primary research questions for this review were:

l Which interventions are effective for reducing the initiation, or continued use, of illicit
drugs and related harmful behaviours amongst children and young people aged up to 25
years?
l Which interventions are effective for reducing harmful behaviours related to illicit drug
use?
l Which interventions are effective at treating drug misuse amongst people who misuse or
who are dependent upon illicit drugs?
l What interventions are effective at supporting people who misuse illicit drugs to fully
recover from their illicit drug misuse and become better reintegrated into the community
following/alongside treatment?
The review highlighted a number of drug prevention, harm reduction and treatment
interventions that are supported by evidence as having positive effects on drug-related
outcomes.
Rapid Expert Review

The Minister appointed an independent international expert panel to carry out a rapid review of
the 2009-2016 strategy 10. The panel was chaired by Paul Griffiths, Scientific Director, EMCDDA
and included Professor Sir John Strang, Director, National Addictions Centre, Kings College
London and Nicola Singleton, Scientific Analyst, EMCDDA. The main objectives of the Rapid
Expert Review were to examine the progress and impact of the strategy and to highlight areas
for consideration in the development of this Strategy.
The expert panel considered the 2009-2016 strategy to have been ‘well-crafted and
comprehensive’ when compared to other European strategies and focused on issues that
were a priority at the time, such as heroin use, particularly in inner city areas. Several issues
have emerged since 2009, which require an up-to-date response in the opinion of the panel,
in particular, the use of cocaine, new psychoactive substances, and the emergence of a more
diverse social profile of users, including an aging population of opioid users. Their report also
noted that the drug market has become increasingly globalised and that the internet has
presented particular challenges to law enforcement.
Many key stakeholders interviewed by the panel highlighted the fact that the current Drug
and Alcohol Task Force boundaries were no longer adequately reflecting the pattern of drug
problems around the country. As a result, the panel formed the view that there are gaps in
service provision and inequitable allocation of resources. They recommended a review of Task
Force boundaries in light of current needs and suggested that the results of the 2014/15 general
population survey and estimates of opiate prevalence would provide a good basis for such a
review.
The panel considered that the five pillar format of the strategy, which focused on supply
reduction, prevention, treatment, rehabilitation and research, had encouraged joined up inter-
agency working, but may have been unhelpful in facilitating cross-pillar coordination where
actions related to a number of pillars. To provide greater coherence, they recommended an
overarching long-term vision, a few key goals with specific objectives, related actions and
appropriate performance indicators. They also highlighted the importance of developing
synergies with other relevant strategies, such as the alcohol-focused National Substance Misuse
Strategy 9, mental health strategies and policy documents related to homelessness and Healthy
Ireland.
For the future, they recommended that the strategy should focus on achieving equality of
access to evidence-based services that adhere to quality standards and are responsive to
changing needs, such as new drugs, new patterns of use and new groups of users. They said
that the perspective and engagement of those affected by substance misuse should be integral
to the process of developing the new strategy.
CHAPTER 2 – Vision, Values and Goals
Vision
The vision of the strategy aims to create:
“A healthier and safer Ireland, where public health and safety is protected, and the
harms caused to individuals, families and communities by substance misuse are reduced
and every person affected by substance misuse is empowered to improve their health,
wellbeing and quality of life.”
This vision recognises the importance of responding to the harms caused by substance misuse
which impacts on individuals, families, communities and wider society, and helping those who
develop drug or alcohol problems to address their personal health needs and improve their
health, wellbeing and quality of life.
Values
The new strategy is guided and underpinned by the following values:
l Compassion
A humane, compassionate approach focused on harm reduction which recognises that
substance misuse is a health care issue.
l Respect
Respect for the right of each individual to receive person-centred care based on his or
her specific needs and to be involved in the development of their care plan.
l Equity
A commitment to ensuring people have access to high quality services and support
regardless of where they live or who they are.
l Inclusion
Diversity is valued, the needs of particular groups are accommodated and wide-ranging
participation is promoted.
l Partnership
Support for maintaining a partnership approach between statutory, community and
voluntary bodies and wider society to address drug and alcohol issues.
l Evidence-informed
Support for the use of high quality evidence to inform effective policies and actions to
address drug and alcohol problems.
Taken together, these values underpin the goals, objectives and actions in this strategy and
reinforce the Government’s commitment to adopt a health-led approach to substance misuse
and to provide the supports that are necessary to help people recover their health, wellbeing
and quality of life.
Goals
Goal 1
Promote and protect health and wellbeing
A healthy population is a major asset for society, and improving the health and wellbeing of
the nation is a priority for the Government and the whole of society. Healthy Ireland 3, Ireland’s
framework for improved health and wellbeing, aims to support people and communities in
making more positive changes, to address the social determinants of health and thereby reduce
health inequalities, and to influence the wider environment to enable healthier choices by
everyone. This strategy aims to protect the public from threats to health and wellbeing related
to substance misuse by preventing early use of alcohol and other drugs among young people,
influencing behaviour and challenging social norms and attitudes and providing targeted
interventions aimed at minimising harm for those who have already started to use substances.
Goal 2
Minimise the harms caused by the use and misuse of substances and promote
rehabilitation and recovery
This goal recognises the role of the individual in addressing his or her dependence on
alcohol and other drugs, and that the context within which drug dependency develops has
a fundamental impact on the type of response that is most appropriate to addressing it. It
also acknowledges that substance misuse affects not only those who have developed a drug
or alcohol problem, but also their families, the community and the wider society. Therefore,
interventions and supports are needed to target not only those who have developed a problem
due to the misuse of substances, but also those harmed by another person’s drug and alcohol
use. It is also important to provide tailored interventions to effectively address the needs of
those who face a higher risk of substance misuse because of their lifestyle or because they
belong to a specific group or community of interest.
Goal 3
Address the harms of drug markets and reduce access to drugs for harmful use
Protecting the public from dangerous or potentially dangerous substances and their harmful
effects is a core objective of Ireland’s drug control framework. Gathering information and
intelligence at national and international level is a vital part of the work involved in intercepting
drugs destined for the Irish drug market. It strengthens the response to organised and
gang-related crime, involved in the supply of drugs and related criminal activities. Effective
monitoring of the drugs situation, and the public health threats associated with the supply of
illegal substances, including new drugs, is required to address the harms of the drug market and
reduce access to drugs for harmful use. Addressing the harmful aspects of the drugs situation
in communities, such as drug-dealing and drug-related crime and intimidation, requires a
collaborative effort, across a range of agencies and sectors of society.
Goal 4
Support participation of individuals, families and communities
Building the capacity of communities to respond to the drugs situation is a key goal of
Reducing Harm, Supporting Recovery. Building social capital is seen as particularly important
in those communities that are most impacted by socio-economic disadvantage, marginalisation
and exclusion, as such communities may require more targeted interventions to address the
issues they face. The full involvement of all stakeholders, including people who use services and
others affected by problem substance use, in the design, implementation and review of services,
policies and strategies is also of vital importance. Throughout this strategy, the term service
user is used to include people who use healthcare services, their parents, guardians, carers and
families, organisations and communities that represent the interests of people who use health
and social care services, as well as potential users of healthcare services such as people who
currently use drugs. Family members have a particularly important role to play, as they may be
involved in supporting a loved one with a drug problem and may be service users in their own
right.
Goal 5
Develop sound and comprehensive evidence-informed policies and actions
Improving our knowledge and understanding of the drugs problem is a core objective of
Reducing Harm, Supporting Recovery. For this reason, a sound and comprehensive evidence-
base is needed for policies and actions. Information systems which monitor trends and patterns
in drug use and availability, evaluation of programmes and research into the causes and
consequences of substance misuse will be supported under the new strategy.
CHAPTER 3 – Goal 1: Promote and protect
health and wellbeing
Introduction
As a nation, we are seeing increasingly higher rates of substance use. One in four (26.4%) adults
has tried an illegal drug at least once in their lifetime and about 24% of the population have
used cannabis at some point in their lives. The 2014/15 All Ireland Drug Prevalence Survey 6
shows higher rates of cannabis use in the last year, (an indicator of recent use) and last month,
(an indicator of current use), than previous surveys. As illustrated in Figure 2 below, the rising
trend in last year cannabis use evident in Ireland can also be seen in other northern European
countries, while the long-term decreasing trends in Spain and the United Kingdom have
stabilised 13.
Figure 2: Last year prevalence of cannabis use among young adults (15-34):
selected trends
25.0
20.0
15.0
10.0
5.0
0.0
2000 2002 2004 2006 2008 2010 2012 2014 2016
France Denmark Finland Ireland

Germany Sweden
Source: (EMCDDA, 2017)
Ireland also has a high level of alcohol consumption and many Irish people engage in
harmful drinking patterns which have significant health, social and economic costs. Alcohol
consumption in 2014 was 20.9% higher than the target of 9.1 litres per capita per annum,
recommended in the National Substance Misuse Strategy. Survey data from the 2013 National
Alcohol Diary Survey 14 indicate that drinkers in Ireland consume alcohol in an unhealthy pattern;
l 37.3% of drinkers engaged in monthly risky single-occasion drinking (RSOD), more
commonly known as binge drinking, in the previous year;
l 54.3% of drinkers had a positive score on the AUDIT-C screening tool and would be
classified as harmful drinkers, indicating that 1.35 million harmful drinkers in Ireland;
l 6.9% scored positive for dependence, which indicates that there were somewhere
between 149,300 and 203,897 dependent drinkers in Ireland in 2013; and
l At least three-quarters of the alcohol consumed was done so as part of a risky
single-occasion or binge drinking session.
Figure 3: Harmful drinking patterns among 18–75-year-old Irish drinkers
(National Alcohol Diary Survey 2013)
9
8
7
6
5
4
3
2
1
0
Monthly RSOD Positive AUDIT-C Score Positive DSM-IV Score
Males Females All Drinkers
The figures presented here are probably an underestimate of the extent of harmful drinking as
there is strong evidence that surveys of self-reported alcohol consumption result in estimates
of per capita consumption well below the level calculated from alcohol sales data.
People who use substances in a harmful way can be influenced by a complex set of factors,
including the publicity messages to which they are exposed, the availability of alcohol, tobacco
and illegal drugs and social, cultural and environmental norms.
This strategy adopts a population health approach to addressing the underlying reasons
for substance misuse, recognising that behaviour change is complex, challenging and takes
time. It puts the needs of people and communities at the centre of the response to substance
misuse and empowers people to take charge of their own health. It reinforces key measures
in the National Substance Misuse Strategy 9, which aim to support people and communities
in making more positive changes and to influence the wider environment so that the healthier
choice is the easier one for everyone. It complements the Public Health (Alcohol) Bill 15, which
contains the proposed legislative provisions to provide a public health response to issues
associated with alcohol consumption in Ireland.
The measures contained in the Public Health (Alcohol) Bill relate to the recommendations
contained in the Steering Group Report on a National Substance Misuse Strategy. The Public
Health (Alcohol) Bill aims to reduce alcohol consumption and to reduce the harms associated
with alcohol.
The strategic objectives of the Bill are to:

l reduce consumption to the OECD average by 2020 (i.e. 9.1 litres of pure alcohol
per capita).
l ensure that the supply and price of alcohol is regulated and controlled in order
to minimise alcohol related harm and
l delay children and young people using alcohol.
Recognising that there is no single simple answer, the Public Health (Alcohol) Bill includes a
range of measures designed to collectively have a positive impact on the health and well-being
of Irish people. Those measures include introducing a minimum unit price for alcohol, health
labelling on products that contain alcohol, restrictions on the advertising and marketing of
alcohol, the separation of alcohol products in retail outlets and the regulation of sponsorship
and promotions.
Objective 1.1: Promote healthier lifestyles within society

Substance misuse prevention strategies targeting families, schools and communities are an
effective way of promoting health and wellbeing among the general population and result in
wider benefits for society in terms of savings in future health, social and crime costs. Prevention
strategies include measures to prevent early use of alcohol and other drugs among young
people, reduce the misuse of alcohol and other drugs, and minimise harm, where drug use has
already started.
Raising awareness of the risks of substance use and increasing understanding of the harmful
effects of substance misuse on the health of the user and other people in the person’s life is
an important part of the work of prevention. DATFs have made a significant contribution in
this area through organising local and regional awareness initiatives and promoting evidence-
based approaches to community action on alcohol that raise awareness of alcohol-related harm.
Support for these initiatives will continue under the new strategy.
Evidence suggests that education and awareness programmes that are delivered alongside
other measures, which build the lifeskills and confidence necessary to support positive
behaviours and choices, are more likely to be effective in encouraging protective and healthy
behaviour than stand-alone measures. On the other hand, initiatives that use scare tactics or
testimonials from ex-drug users to discourage drug use can be counterproductive and may
have little impact on changing behaviour 12.
Effective drug prevention involves integrated holistic policies and actions, which take account
of the different risk factors for substance use, such as parental substance misuse, family
circumstances, peer pressure, school or work life, lifestyle reasons and socio-economic factors.
Promoting a joined up approach between different government policies and strategies that
may have a bearing on the risk factors for substance misuse is important in this context.
Prevention is a collaborative effort, which involves a range of stakeholders, including parents

and families, those working in education, DATFs, family support networks, youth services,
student unions, sporting organisations and networks of people who use drugs. Prevention
programmes should be evidence-based, adhere to quality standards and involve participants
in programme design and implementation.
Using manual-based programmes, which set out the practical aspects of the intervention and
ensuring programmes are implemented and regularly evaluated, all increase the likelihood
of success and better outcomes. A coordinated and consistent approach to prevention and
education interventions will be achieved by supporting specific capacity building initiatives
aimed at the relevant sectors and interests groups involved in drug and alcohol education.
No. Strategic Action Delivered by: Lead Partners
Agency
1.1.1 Ensure that the a) Developing an initiative to ensure DOH HSE,

commitment to an that the commitment to an DATFs
integrated public health integrated public health approach
approach to drugs and to drugs and alcohol is delivered
alcohol is delivered as a as a key priority; and
key priority. b) Promoting the use of evidence
based approaches to mobilising
community action on alcohol.
1.1.2 Improve the delivery of a) Organising a yearly national HRB HSE,

substance use education forum on evidence-based and DOH,
across all sectors, effective practice on drug and DES,
including youth services, alcohol education; and DCYA
services for people using b) Developing a guidance
substances and other document to ensure substance
relevant sectors. use education is delivered
in accordance with quality
standards.
Objective 1.2: Prevent use of drugs and alcohol at a

young age
Better Outcomes, Brighter Futures 16, the national policy framework for children and young
people, 2014-2020, provides an additional context for this strategy to promote and protect
the health and wellbeing of children and young people. In particular, Better Outcomes, Brighter
Futures commits to a whole-of-Government and whole-of-society approach to supporting
children and young people achieve good physical, mental, social and emotional health and
wellbeing to make positive choices to be safe and protected from harm and realise their
potential.
Preventing or delaying substance use aims to reduce the negative health and social
consequences of drug and alcohol use in society and is therefore an important element in
promoting healthier lifestyles and a healthy society generally. Using substances at a young
age increases the likelihood of developing problems with alcohol and other drugs later in life.
There are physical health risks associated with drug and alcohol use, and adolescents who
use the substances expose themselves to those risks over a longer period of time. Family
circumstances, socio-economic status and a lack of educational attainment can be underlying
reasons for early substance use, and drug use in adolescents frequently overlaps with other
mental health problems.
Surveys from the past ten years show that the greatest increases in drug use are amongst
younger people 6. Figure 4 illustrates that the proportion of young people consuming illegal
drugs in the last year has risen since 2002/03. Last year use of ecstasy among 15-34 year olds
rose sharply from 0.9% in 2010/11 to 4.4% in 2014/15.
Figure 4: Last year prevalence of substance use among 15-34 year olds
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
2002/2003 2006/2007 2010/2011 2014/2015
Any illegal drug Cannabis Ecstasy Cocaine
Data Source: Prevalence of drug use and gambling in Ireland and Northern Ireland. Bulletin 1
The proportion of 15-34 year olds reporting using cannabis in the last month has almost
doubled since 2010/11 as illustrated in Figure 5.
Figure 5: Last month prevalence of cannabis use (%)
9
8
7
6
5
4
3
2
1
0
2002/2003 2006/2007 2010/2011 2014/2015
15-34 age group 35-64 age group
Source: Prevalence of drug use and gambling in Ireland and Northern Ireland. Bulletin 1
School-based interventions
Most universal prevention programmes take place in an educational setting. In Ireland,
substance use education in primary and post primary schools has been developed through
Social, Personal and Health Education (SPHE). The 2015 Life Skills Survey (forthcoming)
indicates that more than 90% of schools provide their students with information on alcohol
and drug misuse through SPHE and other means and that 95% of post primary schools have,
or are progressing, a substance abuse policy. DATFs can play a valuable role in supplementing,
complementing and supporting a planned, comprehensive and established SPHE programme.
Building the capacity of young people to take charge of their own physical and mental health
and wellbeing is at the heart of a whole-school health promotion approach to substance misuse.
The Action Plan for Education 17 aims to ensure resilience and personal wellbeing are integral
parts of the education and training system.
Evidence suggests that comprehensive school-based programmes that combine social and
personal development and provide information about substance use are more likely to be
effective in preventing early substance use. This is the approach recommended in the Action
Plan for Education 17 and will be a key component of a new wellbeing area of learning to be
introduced at Junior Cycle level from 2017 onwards.
Schools will have flexibility in designing their Wellbeing Programme to ensure that it suits their
students and their local context. They will be encouraged to work towards a shared vision
and set of indicators which describe what is important. Activity, responsibility, connectedness,
resilience, respect and awareness are the six indicators which have been identified as central to
wellbeing.
It will also be important to ensure that SPHE teachers, guidance counsellors and Home School
Liaison co-ordinators are given the opportunity to avail of continuing professional development
to build their capacity to deliver substance use education in line with the Action Plan.
In addition, Wellbeing Guidelines that provide a clear and rational structure to support the
promotion of health and wellbeing in all schools, have been developed by the Department of
Education and Skills, the Department of Health and the Health Service Executive and the Action
Plan is committed to the roll out of a national programme to support the implementation of
these guidelines in all primary and post-primary schools.
Out-of-school interventions
Youth services
Youth services play an important role in developing the confidence, social skills, wellbeing
and resilience of young people. The Department of Children and Youth Affairs’ Value for Money
Policy Review (VFMPR) 18 in 2014 recommended changes to youth funding programmes to
ensure evidence-based, effective, value for money services that secure the best outcomes
for young people, particularly, vulnerable young people.
The VFMPR examined three targeted programmes including the Young People’s Facilities
and Services Fund (YPFSF), which was established in 1998, as part of the Government’s overall
strategy to address drug misuse, in order to assist with the development of youth facilities
(including sport and recreational facilities) in areas where a significant drug problem exists or
has the potential to develop. The review recommended amalgamation of the three programmes
into one targeted programme for youth, as there was significant cross-over in the ‘types’
of needs targeted by the programmes, in particular addressing concerns relating to drugs
misuse, crime/anti-social behaviour and educational disadvantage. This recommendation was
accepted by Government and is now Government policy. The target groups of young people
are unchanged under the new scheme.
The review recommended that service provision for young people would aim to achieve seven
key outcomes which could have a positive impact on delaying the onset of substance misuse.
These seven outcomes are:
l Communication,
l Confidence/agency,
l Planning and problem-solving,
l Relationships,
l Creativity,
l Resilience and determination, and
l Managing feelings.
In order to address the above outcomes, DATFs will be supported to develop targeted,
appropriate and effective services for young people at risk of substance misuse, focused on
social and economically disadvantaged communities.
Family-based interventions
Children living in communities with higher prevalence of problem substance use are at
increased risk of developing problems themselves. For some of these children there are early
identifiable behaviour patterns that indicate possible problems with substances later in life 12.
Personal trauma or life difficulties are associated with risk taking and resultant harm and very
particular, targeted programmes may offset these risks and reduce the possibility of future
harms. However, these risk factors are not always apparent and even those who may not be
identified as being at risk may develop substance use problems given certain conditions.
Parental involvement and concern are the most important protective factors when it comes
to consuming alcohol, cannabis and other drugs for both early-school leavers and those who
remain in school. Substance use by either parent may increase the likelihood of young people
consuming the same substance. On the other hand, a family environment in which substances
are not used on a regular basis can reduce this risk by limiting experimentation at a young age
and providing positive role models. Awareness of these risk and protective factors can provide
parents with the tools to protect their children against the risks of early substance use.
Young people living with family members who have substance use problems can be supported
through the use of programmes specifically designed for these groups and delivered in informal
settings by youth workers and other support staff. Family-based interventions may reduce
initiation and use of cannabis among adolescents and this approach may be particularly
beneficial in communities most affected by problem drug use 12.
Early school leaving and substance use

Early school leaving rates in Ireland currently stand at 6.9%, compared with an EU average of
11% 19. Nonetheless, those who leave school early are an important target group for prevention
programmes, as there is a substantial overlap between risk factors for early school leaving and
substance use. A 2010 study 20 found that those who left school before completion were more
than twice as likely to have tried cannabis and other drugs, while having a positive experience
of school and learning reduces the risk of substance misuse. Recent educational research 21
shows that student disaffection, a lack of connectedness to school, as well as a poor school
climate, are themes in accounts of early school leaving.
Social class and gender can influence the risk of early school leaving. Developmental issues,
emotional and behavioural disorders, mental health concerns, poor attainment and learning
disabilities are also risk factors, which can lead young people to struggle with the curriculum,
peer relationships and the school community. This can result in a gradual disengagement, early
school leaving and consequent greater risks of substance misuse.
There are a number of initiatives and programmes that aim to address the factors that influence
early school leaving and improve school retention rates. These include:
l the School Completion Programme and the Home School Community Liaison Scheme;
l the Department of Education’s Programme “Delivering Equality of Opportunity in
Schools” (DEIS), which has seen significant improvements in retention rates in DEIS
schools in recent years;
l Meitheal, the TUSLA national practice model, an interagency model of work to ensure the
effective delivery of services for “at risk” young people; and
l the Department of Housing, Planning and Local Government’s Social Inclusion and
Community Activation Programme (SICAP), which provides supports to children and
young people from target groups who are at risk of early school leaving and/or not in
employment, education or training aged between 15 and 24.
Providing a continuum of support and ensuring access to resilience building programmes,

counselling/guidance supports, educational or psychological assessments are ways in which
young people at risk of early school leaving can be supported. There are a number of further
measures planned in the coming years which aim to benefit young people who may be at risk of
disengaging from school.
During 2017, a School Completion Strategy will be developed by the Department of Children
and Youth Affairs in collaboration with TUSLA Educational and Welfare Services and the
Department of Education and Skills and a review of senior cycle programmes and vocational
pathways will be undertaken by the Department of Education and Skills to ensure that those
who do not seem to thrive in a traditional academic setting complete their education. The
review will include all those in the 16–18 age range and cover the range of programmes and
vocational pathways currently provided in this regard – Leaving Certificate, Leaving Certificate
Applied, Leaving Certificate Vocational Programme, Transition Year, Youthreach and Community
Training Centres, Special Education, and other relevant programmes.
The State has invested a lot of resources in providing some excellent facilities for schools. The
availability of such school facilities outside the times they are required to deliver mainstream
education could facilitate many positive initiatives, particularly in disadvantaged areas, such as
sport, recreation, music and artistic activities. This would enable communities to meet the needs
of young people and the wider community much more effectively, at little extra cost to the
State.
Agency
1.2.3 Support the SPHE a) Promoting continued effective DES,

programme. communications between local DATFs
schools and Drug and Alcohol (Joint)
Task Forces given the importance
placed on the continued building
of strong school community links;
and
b) Ensuring that all SPHE teachers, DES
guidance counsellors and Home
School Community Liaison co-
ordinators can avail of continuing
professional development.
1.2.4 Promote a health In line with the Action Plan for DES DOH/
promotion approach to Education HSE
addressing substance a) Commencing and rolling out
misuse. a national programme to
support the implementation
of the Wellbeing Guidelines to
all primary and post-primary
schools; and
b) Developing Wellbeing Guidelines
for Centres of Education and
Training.
1.2.5 Improve supports for a) Providing a continuum of support DES HSE

young people at risk of including a Student Support Plan
early substance use. as appropriate, for young people
who are encountering difficulty in
mainstream education;
b) Providing access to timely DES
appropriate interventions such as HSE
resilience-building programmes,
TUSLA
and/or counselling, educational
assessments and/or clinical (Joint
psychological assessments, as Leads)
appropriate;
c) Implementing School Attendance TUSLA DES
Strategies in line with TUSLA’s
guidance;
d) Prioritising initiatives under the DES TUSLA
new DEIS programme to address
early school leaving; and
e) Providing supports including DHPLG
homework clubs, additional
tuition, career guidance/
counselling support, community
awareness of drugs programme
and youth work in collaboration
with schools and other youth
programmes/schemes.
1.2.6 Ensure those who do Reviewing Senior Cycle programmes DES

not seem to thrive in and Vocational Pathways in senior
a traditional academic cycle with a view to recommending
setting complete their areas for development.
education.
Agency
1.2.7 Facilitate increased use Engaging with property owners DES

of school buildings, and school authorities to facilitate
where feasible, for increased use of school buildings,
afterschool care and out where feasible, for afterschool care
of hours use to support and out of hours use to support local
local communities. communities.
1.2.8 Improve services for Developing a new scheme to provide DOH DCYA,
young people at risk targeted, appropriate and effective HSE,
of substance misuse in services for young people at risk of DATF.
socially and economically substance misuse, focused on socially
disadvantaged and economically disadvantaged
communities. communities.
Objective 1.3: Develop harm reduction interventions

targeting at risk groups
Children at risk
Children of parents who misuse substances are more likely to be at a higher risk of physical,
psychological and emotional harm, compared to children whose parents do not misuse drugs or
alcohol 22. As the effects of parental substance misuse on children can be difficult to detect, this
phenomena is often described as “Hidden Harm.”
Not all children in homes where substances are misused experience harm as a result, but
children living with parental problem substance use are more likely to experience mental
health problems, academic under-achievement, have poor social skills and be more prone to
developing substance misuse problems themselves later in life. Genetic factors combined with
physical and emotional neglect and exposure to poor parenting can impact on a child’s social
and emotional maturation, development of social competencies and undermine reliance and
the capacity for emotional regulation, all established determinants for substance misuse in
adulthood.
Analysis of general population survey and treatment data can provide estimates of the numbers
of children of parents who misuse substances and may help in determining the scale of the
interventions needed to respond to this problem. For family-based interventions, prevention
experts recommend approaches that involve the whole family rather than those that train
parents alone.
Evidence suggest that prevention interventions targeting those at risk may be more effective
if they involve both schools and parents, are interactive and have positive goals. There is some
evidence that family interventions may be effective in delaying or reducing drug use but
there is not a great deal of research on family interventions targeted at children of drug-using
parents 23.
A coordinated response to the needs of children in families where substances are misused will
help to protect these children from harm. Addiction and other services providing support to
children can work closely together and agree protocols for exchanging information, agreeing on
referrals and for sharing other responsibilities in this sensitive area.
For young people with substance use problems, family therapies may be effective in reducing
drug use frequency and severity in comparison to other interventions among adolescents,
including cognitive behavioural therapy (CBT). For very young at-risk children, interventions
that are aimed at strengthening relationships between children and their parents and
developing parenting skills can impact on child behaviour. As with universal prevention
programmes these interventions are more likely to be successful if they are delivered by trained
professionals through frequent sessions. There is a need to ensure continued support for family
support programmes. Strengthening Families, Parenting under Pressure and the 5 step method
(Stress-Strain-Coping-Support model) are examples of programmes that have been supported
in Ireland to build the resilience of families and support them in their own right.
Children leaving care

Young people leaving care and detention services, particularly from residential or hostel
accommodation, are more at risk than the general population of homelessness, mental health,
addiction problems, and isolation. The Ryan Report 24 recommends that consideration be given
as to how best to provide necessary once-off support to young people leaving care to help
them gain practical life-long skills in order to reduce their risk of developing substance use
problems. Specific psychological programmes and mental health information are necessary
to help them build their resilience to cope as independent adults and to develop protective
factors against substance use. The Meitheal interagency model can make a key contribution
towards ensuring the delivery of effective services for ‘at risk’ young people who face multiple
challenges, such as young people leaving care.
Risks associated with belonging to particular groups or sub-populations

Research suggests that third level students and Lesbian, Gay, Bisexual, Transgender and Intersex
(LGBTI) young people may be far more likely to take illegal drugs and/or binge drink than the
general population. The most recent results of the National Student Drug Survey 25 found that
82% of respondents had tried illegal drugs, with 35% of respondents binge-drinking on at least
a weekly basis. In an earlier online survey of LGBTI youth, 65% of respondents had taken drugs,
the majority of which had taken some drug within the preceding month.
The “Men who have sex with men internet survey Ireland” 26 (MISI) published in 2016, reported
that 36% of respondents had used recreational drugs within the previous 12 months: the most
commonly used were cannabis (28%), MDMA (17%) and cocaine (13%). Over half (58%) of
respondents reported that they binge drank on a typical drinking occasion, and 44% binge drink
every week. Separately, a 2016 survey of men attending the Gay Men’s Health Service (GMHS)
in Baggot Street, Dublin noted that 27% of respondents reported that they had engaged in
chemsex (used drugs for or during sex) within the previous 12 months; the most commonly
used drugs were gamma-hydroxybutyric acid/gamma-butyrolactone (GBH/GBL), cocaine,
ketamine and chrystal methamphetamine.
While prevalence of new psychoactive substances (NPS) use is relatively low in the general
population, the increase in the rate of deaths involving NPS from 8 in 2012 to 28 in 2013, and
23 in 2014 is a cause for concern 8. Moreover polydrug use, including alcohol can increase the
risks associated with NPS use. This underlines the ongoing need for targeted initiatives to raise
awareness of the dangers and significant mental and physical health effects that can be caused
by NPS use.
Use of image and performance enhancing drugs (IPED) can also put people at risk. Service
providers report an increase in clients of their needle exchange programmes who use IPED,
such as steroids. Existing harm reduction services are traditionally geared towards users of
psychoactive substances. Given the divergent profile and nature of substance use among
IPED users, there is a need to develop a tailored approach in response to the profile of harm
within this group. Expanding the range and nature of models of practice may serve to enhance
accessibility, engagement, and effectiveness. There may be a case for developing a specialised
IPED clinic for those currently using mainstream needle exchange services 27.
These findings point to the need for targeted harm-reduction, education and prevention
measures that are tailored towards these higher risk groups. These may include education,
information and interaction with people who use drugs in environments where drug taking can
occur (e.g. festivals, nightclubs etc.). Harm reduction initiatives and drug welfare are becoming a
mainstream part of festivals in many European countries and there have been similar initiatives
in Ireland. The development of IT/web based drug education, harm reduction and brief advice
tools targeted at 3rd level students, which have a component signposting to locally available
supports, will be a key element of the prevention strategy. The development of such initiatives
will need to be compatible with national drug prevention programmes and involve the relevant
networks, such as student and LGBTI organisations. The engagement of people who use drugs
and/or services in the development and roll-out of any awareness campaigns is particularly
important to ensure relevance and accuracy.
Examples of awareness initiatives targeting 3rd level students include the “What’s In The Pill?”
campaign, and SpunOut’s targeted online advertising. Online awareness campaigns along
the lines developed by Drugs.ie, which use advertisements on Facebook and Twitter, as well
as active engagement with online discussion sites and other online media outlets frequented
by young people, play an important role in highlighting the risks of psychoactive substances.
Similarly, targeted awareness campaigns, such as the Drugs.ie campaign on the use of GBH/
GBL, highlight particular issues among high-risk groups or about particular patterns of drugs
use.
In order to respond to emerging trends such as high risk behaviours associated with lifestyle
choices or risky patterns of substance use, a need has been identified to establish a working
group to undertake an examination of the evidence on the effectiveness of early harm reduction
responses, such as targeted information campaigns, drug-testing and amnesty bins to respond
to emerging trends. This will be pursued by the HSE in conjunction with other relevant
stakeholders.
Agency
1.3.9 Mitigate the risk and a) Developing and adopting HSE, NFSN
reduce the impact of evidence-based family and TUSLA C&V
parental substance parenting skills programmes for (Joint sectors
misuse on babies and services engaging with high risk Leads)
young children. families impacted by problematic
substance use;
b) Building awareness of the hidden
harm of parental substance
misuse with the aim of increasing
responsiveness to affected
children;
c) Developing protocols between
addiction services, maternity
services and children’s health
and social care services that will
facilitate a coordinated response
to the needs of children affected
by parental substance misuse;
and
d) Ensuring adult substance use
services identify clients who
have dependent children and
contribute actively to meeting
their needs either directly or
through referral to or liaison
with other appropriate services,
including those in the non-
statutory sector.
1.3.10 Strengthen the life-skills Considering how best to provide TUSLA

of young people leaving necessary once-off supports for Care
care in order to reduce Leavers to gain practical life-long
their risk of developing skills in line with Action 69 of the
substance use problems. Ryan Report in order to reduce their
risk of developing substance use
problems.
1.3.11 Strengthen early harm Establishing a working group to HSE DOH

reduction responses to examine the evidence in relation to
current and emerging early harm reduction responses, such
trends and patterns of as drug testing, amnesty bins and
drug use. media campaigns, to current and
emerging trends including the use
of new psychoactive substances and
image and performance enhancing
drugs and other high risk behaviours,
including chemsex.
Performance indicators related to Goal 1
l Reduction in the use of illegal drugs in the last year (Drug Prevalence Survey).
l Reduction in the alcohol consumption rate (Drug Prevalence Survey).
l Increase in knowledge with respect to the harms of alcohol, cannabis and other drugs
(Drug Prevalence Survey, other sources).
l Delaying the age of first use of illicit drugs (ESPAD survey).
l Delaying the age of first drink (Drug Prevalence Survey, ESPAD survey).
l Reduction in binge drinking among young people (ESPAD, Drugs Prevalence and HBSC
Surveys).
l Stabilisation in recent and reduction in current prevalence of illicit drugs in 15-24 year old
population (Drug Prevalence Survey).
l Stabilisation in recent and reduction in current prevalence of illicit drugs in 15-24 year old
population (Drug Prevalence Survey).
l Prevalence of children living with parental substance misuse (GUI survey (Growing up
in Ireland), NACDA research on children living with parental substance misuse).
l Identify the number of children who come to the attention of child protection services
as a result of parental substance misuse (Children in Care dataset, HSE).
CHAPTER 4 – Goal 2: Minimise the
harms caused by the use and misuse
of substances and promote rehabilitation
and recovery
Introduction
Problem substance use is a chronic, often recurring condition that can cause substantial harm
to the person concerned. As a result, recovery is often seen as a journey, and rehabilitation as
a process, that supports and encourages the individual at each stage along the pathway to
recovery. Recovery is a personal matter. A successful outcome or improvement for one person
may involve improving their quality of life and overcoming reliance on their primary drug of
dependence. For another person, the ultimate goal for their own recovery may be to become
drug free. In order to promote recovery and minimise the harms caused by substance misuse,
timely access to appropriate services relevant to the needs and circumstances of the person
concerned is of fundamental importance.
Objective 2.1: To attain better health and social outcomes

for people who experience harm from substance misuse
and meet their recovery and rehabilitation needs
Continuum of care model
The HSE has developed a 4-tier person-centred model of rehabilitation based on the principle
of a “continuum of care” that allows the individual to access the range of supports they need
to achieve their personal recovery goals in line with their needs and aspirations 28. This model
of care is designed to enable people to receive the support they need as close to home as
possible, and at the level of complexity that best corresponds to their needs and specific
circumstances. The various types of intervention and the settings in which they are provided are
set out in Figure 6 below.
Information, advice and referral interventions are provided through Tier 1 of the model. Tier
1 interventions also include the type of social reintegration and rehabilitation support and
wraparound services that a person may need following specialist treatment provided in Tier 3 or
Tier 4 settings. These interventions are made available through an integrated system of support
that includes education and training, employment, housing, family support, general health and
other services.
Tier 2 includes harm reduction support, which may be provided by a pharmacy or in a

community setting, and also includes some specialist addiction services. Many of these
services are provided by agencies which adopt a low threshold approach, meaning that the
requirements to access these services are kept to a minimum.
In Tier 3 treatment and rehabilitation services provide specialist interventions in a range of

settings dedicated to this purpose.
Specialised and dedicated inpatient or residential units or wards provide Tier 4 interventions,
which include inpatient detoxification, sometimes linked to residential rehabilitation units, or
assisted withdrawal and stabilisation.
Figure 6: The Four Tier Model of Care
TIER 1
Interventions where
main focus is not
drug treatment
Family Social
TIER 2
support care
Drug-related
interventions
TIER 3 Community
Job Pharmacies Specialist drug- based Housing
seeking related interventions
support
skills
TIER 4
Specialist
Prison dedicated Community
setting inpatient or setting
residential
units or
Employment wards Education
support services
Primary Hospital
Outreach
care setting
Specialist Criminal
Vocational addiction justice &
training services probation
services
General
healthcare
setting
Source of image: Doyle J, Ivanovic J National Drugs Rehabilitation Framework Document. National Drugs Rehabilitation
Implementation Committee. Dublin: Health Services Executive 2010.
The recognition that no one service can cater for the diverse needs of the service user is key to
improving health and social outcomes for people who experience harm as a result of substance
misuse. Case management aims to increase engagement with different services and to achieve
common goals through providing an integrated care pathway for the service user. Evidence
suggests that it is an effective approach to retaining people in treatment.
The HSE has developed a National Drugs Rehabilitation Framework 29 (NDRF) which
acknowledges that the integrated care pathway is the shared responsibility of a range
of agencies. These may include education, training and employment, health, welfare and
housing sectors, depending on the circumstances of the individual concerned. The framework
contains broad national protocols to facilitate inter-agency working, covering issues such as
confidentiality, common assessment tools, referral procedures and conflict resolution between
agencies.
As part of the NDRF, the HSE has devised a structured and evidence based model of screening
and brief intervention that is undertaken prior to the key working, care planning and case
management phases of service provision. It enables an initial assessment to be made in relation
to problem alcohol and substance use in order to intervene early with at-risk groups in a variety
of settings and refer the person on to relevant services as appropriate.
The HSE has also developed a series of training programmes on the NDRF, including an online
training package on key working and care planning, aimed at drug and alcohol services, and
homeless services involved in the rehabilitation process. The intention is to expand this training
to a range of other services and settings in order to achieve integrated case management,
seamless transition between services and optimal pathways to recovery for people who use
addiction services. This will include training on screening and brief intervention.
Improving access to services

Ensuring timely access to health and social care services and extending the range of treatment
options available is integral to achieving better outcomes. Recent evidence provides some
indication of likely future trends and the types of challenges in the years ahead. An aging
heroin-using cohort, the proliferation of new psychoactive substances, polydrug use and the
changing geographic and demographic profile of the drug problem are among the issues that
will contribute to the demand for services under this strategy.
Drug treatment services have been expanded throughout the country over the past decade to
respond to a rising demand for drug treatment. Much of this expansion has concentrated on
improving access to opioid substitution treatment (OST) and harm reduction initiatives, such
as needle exchange programmes, outside Dublin, especially in areas of the country that have
experienced opioid problems more recently. Community-based drug projects have contributed
towards expanding the network of services by delivering an integrated holistic service on the
ground in their communities on behalf of statutory agencies.
In the past ten years, the number of residential beds has increased significantly, largely due
to the increased provision of beds in community-based residential facilities. The most recent
figures available (including private provision) estimate current provision at 787 residential beds,
comprising 23 inpatient unit detoxificiation beds, 117 community-based residential detoxification
beds, 4 adolescent residential detoxification beds, 625 residential rehabilitation beds and 18
adolescent residential beds.
The rising demand for drug treatment is evident in the treatment figures in the past decade 11.
The numbers of new treatment cases, excluding alcohol, increased from 2,278 to 3,742 between
2006 and 2015 30. The most notable changes were in the numbers of new cases treated for
problem cannabis use, which rose rapidly in the time period, and for benzodiazepines, which
rose steadily between 2008 and 2014, with a small decrease recorded in 2015.
Figure 7: New treatment cases by drug type 2006-2015
4000
Number entering treatment
3500
3000
2500
2000
1500
1000
500
0
2002/2003 2006/2007 2010/2011 2014/2015
Opiates Cocaine Cannabis Benzodiazepines

Total
Data source: National Drug Treatment Reporting System 30
Ireland remains a country with a relatively large opiate problem, and although the
characteristics of this group are changing, they remain a key target for drug treatment services.
Since 2009, the HSE has provided wider access to Opioid Substitution Treatment (OST) around
the country. This has been achieved through the establishment of new treatment centres, the
participation of more GPs in the prescribing of OST and the involvement of more pharmacies in
the dispensing of methadone.
Reflecting the wider availability of OST, the number of clients in receipt of OST as of 31st
December each year increased steadily from 7,260 in 2005 to 10,087 in December 2016. At the
end of December 2008, there were 5,181 patients attending clinics, with a further 452 receiving
OST in prison. At the end of December 2016, the figures were 5,438 and 465 respectively.
Within a GP setting there have been even greater increases. At the end of December 2008,
there were 3,085 patients receiving OST in GP settings, which had increased to 4,184 at the end
of December 2016 (an increase of more than 35%) 31.
Figure 8: Numbers in OST treatment by provider
6000
5000
4000
3000
2000
1000
0
Clinics GPs Prison
Total at end of Dec 2008 Total at end of Dec 2016
Data Source: Data provided by the Central Treatment List
Despite improvements in service provision, people report having to travel a significant distance
to access more specialist treatments, especially in rural areas. The time involved, the cost
of travel, the need for childcare or the absence of a support network can result in barriers
to accessing treatment for some people, even when there are financial supports available.
Difficulties in accessing OST also include a lack of local services and waiting times. A range
of options will therefore be explored to facilitate wider access to OST in the community. This
includes measures to involve more GPs in prescribing OST, an examination of the feasibility
of nurse-prescribing of OST and the provision of OST in a wider range of settings, such as
community-based initiatives or homeless services.
In conjunction with the Irish College of General Practioners, the HSE is working to increase
engagement of all GPs who are trained at Level 1 and Level 2 throughout the country. Level 1
training provides the foundation for treating stable methadone maintained patients. Having
successfully managed a number of patients for at least one year and having completed an
external clinical audit, a GP may progress to Level 2. A Level 2 GP may initiate treatment,
stabilise doses and provide ongoing maintenance treatment to a drug user in the primary care
setting. Ideally all stable methadone patients who are registered with a Level 1 GP should be
transferred to their own GP, where appropriate, provided their own GP has Level 1 training.
People who are dependent on opiates, are engaged in high risk drug use such as injecting,
or who are using multiple substances can also experience barriers to accessing treatment,
especially residential treatment 11. At the end of 2014, there were 9,764 people availing of OST.
The national prevalence estimate of opiate users in 2014 was between 18,720 and 21,454, which
would suggest that there is a considerable number of people who use opiates not currently in
treatment 7. All the participants in a 2009 Irish study on sex work 32, had a history of injecting
drug use and half reported recently injecting drugs. This highlights the need for an effective
response for those with complex interlocking needs.
Some residential services do not have the appropriate level of clinical governance to respond to
those with more complex needs, and may have entry thresholds in place which exclude those
who have more unstable patterns of drug use. Standardising referral processes and lowering
the entry criteria for accessing residential treatment services, while ensuring appropriate levels
of clinical governance, would make it easier for people with more complex needs to access
treatment. The development of residential services that can cater for the needs of those who
use a variety of substances will be particularly important in this context.
It is also intended to improve treatment choices for people who are not clinically suited to
methadone treatment, but require medication-assisted therapy to address dependence on
opiates. There is a commitment in the 2017 HSE Service Plan to provide wider access to
alternative OST products containing buprenorphine or buprenorphine/naloxone.
The National Clinical Effectiveness Committee (NCEC) Standards for Clinical Practice Guidance
(2015) promote consistency of approach for the development of guidelines and guidance such
as policies and protocols. These NCEC National Clinical Guidelines and National Clinical Audit
endorsed by the Minister for Health are mandated for implementation in the Irish health system
and their implementation will be monitored through HSE Performance Assurance Reports,
compliance with the National Standards for Safer Better Healthcare and increased alignment
with the Clinical Indemnity Scheme.
The HSE has published national clinical guidelines for OST to ensure that the quality and safety
of care to the patient is maintained and improved where necessary. The HSE will implement
these guidelines until National Clinical Effectiveness Committee guidelines are in place 31.
Mapping the range of services currently available against underlying need in order to identify
gaps in provision across the country will help to ensure that there is an appropriate mix of
quality services to respond to changing trends and patterns of drug use, including the rising
demand for treatment for cannabis-related problems. It will also be important to continue
developing the capacity of services to respond to those with more complex needs, including
vulnerable groups, such as Travellers or those affected by homelessness, or those with more
high-risk behaviours or patterns of use.

Agency
2.1.12 Strengthen the a) Developing a competency HSE

implementation of framework on key working, care
the National Drugs planning and case management;
Rehabilitation and
Framework. b) Extending the training
programme on the key
processes of the National Drugs
Rehabilitation Framework.
Agency
2.1.13 Expand the availability a) Identifying and addressing gaps HSE C&V
and geographical spread in provision within Tier 1, 2, 3 and sectors,
of relevant quality drug 4 services; DATFs
and alcohol services and b) Increasing the number of
improve the range of treatment episodes provided
services available, based across the range of services
on identified need. available, including:
l Low Threshold;
l Stabilisation;
l Detoxification;
l Rehabilitation;
l Step-down;
l After-Care;
c) Strengthening the capacity of
services to address complex
needs.
2.1.14 Improve the availability Examining potential mechanisms to HSE DOH

of Opioid Substitution increase access to OSTs such as the
Treatments (OSTs). expansion of GP prescribing, nurse-
led prescribing and the provision of
OSTs in community-based settings
and homeless services.
2.1.15 Enhance the quality Implementing the HSE National HSE DOH
and safety of care in Clinical Guidelines on OST and
the delivery of Opioid reviewing in line with National Clinical
Substitution Treatment Effectiveness Committee processes.
(OST).
Promoting recovery by improving access to services for specific groups

of people
The location of services is only one barrier to accessing treatment. Some people may face
additional barriers to accessing treatment because of their own personal circumstances or
because they belong to a particular group or community. In addition, some people do not have
the internal and external resources needed to achieve and maintain recovery from substance
misuse, as well as make behavioural changes. Internal resources may include their resilience,
whereas external resources may be their social networks, family or community supports.
These resources are also referred to as “recovery capital” 33.
Helping individuals to build their recovery capital is at the heart of the continuum of care model,
which is centred on the individual and their needs at each stage in their personal recovery
pathway. A variety of elements can support or jeopardise recovery; these include social
networks, physical, human, cultural and community issues. In the circumstances, developing
social, educational and employment skills should form a key part of individual care plans.
Building a sustainable network of positive relationships contributes to developing recovery

capital. Families can provide practical and emotional support to the person in recovery and
reinforce the beneficial effects of positive social networks. Reconciliation services can support
those who wish to re-establish links with families from whom they have been estranged. Self-
help, mutual aid and peer support can also be beneficial to help build positive social networks
that support people in sustaining their recovery.
Community Drug Projects play an important role in building recovery capital by delivering an
integrated holistic service on the ground in their communities in partnership with statutory
agencies. They are well placed to adapt and respond to the changing needs of service users,
their families and the wider community. A rehabilitation project based in Dublin’s north-inner
city is a good example of a community-based interagency initiative. It provides a structured
assets-based programme of learning and development which gives educational opportunities
to people in recovery who may have left school at a young age.
The contribution that a job can make to progressing and maintaining recovery is well
established 34. The Department of Social Protection’s (DSP) Community Employment
Programme aims to support the development of personal and employment skills and act as
the labour market element in the Continuum of Care. This programme allocates 1,000 places to
people in recovery through a number of dedicated Drug Rehabilitation CE schemes. Building on
the key role of Community Employment (CE) in relation to the rehabilitation, progression and
reintegration into society of recovering drug users, the implementation of the DSP Programme
Framework for CE Drug Rehabilitation Schemes will be monitored under this strategy to
improve overall progression rates.
Often a number of issues need to be addressed before individuals can progress to activation
and job search. Therefore, undertaking wellbeing/self-esteem/confidence building work is often
a starting point for progression towards employment or further education. The Social Inclusion
and Community Activation Programme (SICAP), which is overseen and managed by Local
Community Development Committees (LCDCs) in each local authority area, supports individuals
and marginalised target groups experiencing educational disadvantage or unemployment so
they can participate fully, engage with and progress through life-long learning opportunities
through the use of community development approaches. SICAP programme implementers
engage with participants on a one-to-one basis and agree a personal action plan. SICAP
supports include educational supports, labour market training and occupational specific skills,
career advice and guidance support, employment supports and self employment supports
which assist in moving individuals closer to or into the labour market, which has a positive
effect on the individuals, their families and the wider community. During 2016, 55,890 children
received educational and/or developmental support under SICAP, of which, 782 were identified
as being at risk of early school leaving and a further 5,373 young people aged between 15 and
24 years old who were not in employment, education or training were also supported.
Poverty, deprivation and inequality contribute to the vulnerability that may lead to dependency
and harm and act as barriers to recovery and leading a fulfilling, safe and healthy life. Those
who have completed treatment programmes will continue to need access to aftercare services
and other progression options to enable them to sustain recovery. These options may include
educational support, personal development, training and employment opportunities, as well as
continued access to peer-support. In order to help such groups maintain their recovery, it will
be necessary to increase opportunities for their progression. Identifying and remedying any
barriers to accessing such supports will be important in this context.
Agency
2.1.16 Improve relapse Developing and broadening the range HSE C&V sectors,
prevention and of peer-led, mutual aid and family UISCE, NFSN
aftercare services. support programmes in accordance
with best practice.
2.1.17 Further strengthen a) Developing addiction specific TUSLA HSE, NFSN

services to support bereavement support
families affected by programmes and support
substance misuse. the provision of respite for family
members;
b) Supporting families with
non-violent resistance training to
address child to parent violence;
and
c) Supporting those caring for
children/young people in their
family as a result of substance
misuse to access relevant
information, supports and
services.
2.1.18 Help individuals a) Monitoring and supporting DSP HSE

affected by the implementation of the Other
substance misuse to Department of Social Protection’s relevant
build their recovery Programme Framework for Departments
capital. Community Employment Drug & Agencies,
Rehabilitation Schemes, based C&V sectors
on an integrated inter-agency
approach; and
b) Utilising SICAP to improve the DHPLG
life chances and opportunities
of those who are marginalised
in society, living in poverty
or in unemployment through
community development
approaches, targeted supports
and interagency collaboration.
2.1.19 Increase the range of Establishing a Working Group to: DOH HSE, DSP,
progression options a) Examine the range of IPS, Other
for recovering drug progression options for relevant
users and develop a those exiting treatment, prison, Departments
new programme of Community Employment & Agencies
supported care and schemes including key skills
employment. training and community
participation with a view to
developing a new programme of
supported care and employment;
and
b) Identify and remedy the
barriers to accessing the
range of educational, personal
development, training and
employment opportunities
and supports, including gender
specific barriers and the lack
of childcare provision, for
those in recovery.
Improving access to services for women, children and young people
Women
Women can experience barriers to engaging and sustaining involvement with treatment and
rehabilitation services. Many women in addiction have experienced domestic violence (in their
family of origin and/or in intimate partner relationships) and services should be equipped to
respond appropriately to this issue. There is a need for greater awareness of the implications
of domestic violence, trauma and mental health for treatment and rehabilitation of women
with addictions.
The absence of childcare can be a barrier for women attending treatment and after-care
services. While there are good examples of wrap-around services for female drug-users in
recovery and their children, there is only one residential treatment service located in west
Dublin, where mothers can keep their babies with them during treatment. There is a need to
increase the range of wrap-around services and supports to facilitate more women with children
or who are pregnant taking up treatment.
There are currently three Drug Liaison Midwives, with each attached to one of the three Dublin
maternity hospitals (the Rotunda, the National Maternity Hospital and the Coombe Women &
Infants University Hospital). They are employed by the Addiction services and work in special
clinics in each of the hospitals. The Drug Liaison Midwives see pregnant opioid dependent
women in their clinics, support them throughout their pregnancy and for six weeks post-natal.
They can arrange for inpatient detoxification or stabilisation if necessary and have contributed
significantly to reducing stigma and harm to this vulnerable group of patients.
A study in the Coombe Women & Infants University Hospital 35 in Dublin showed that 4.6%
of women who registered for care reported using drugs during pregnancy, the vast majority
of which related to methadone. These women have complex medical and social needs and
are at an increased risk of having babies with low birth weights and other complications.
Their involvement with the maternity services provides an opportunity to reduce their drug
dependence and improve their social circumstances and wellbeing.
While recent years have seen a decrease in the number of opiate dependent women attending
these services, there are concerns about alcohol use during pregnancy. A 2017 Lancet study
36 found that, of the 50 countries for which data were available, Ireland was one of the five
countries with the highest prevalence of alcohol use during pregnancy.
A National Women & Infants Health Programme (NWIHP) has been established within the HSE
to lead the management, organisation and delivery of maternity, gynaecological and neonatal
services across primary, community and acute care. The National Maternity Strategy 37 made
the following recommendations regarding alcohol and drugs misuse:
l The NWIHP will examine the need to provide drug liaison midwives and specialist medical
social workers in all maternity networks;
l Maternity hospitals/units will strengthen their methods of detecting alcohol abuse and
supporting women to reduce their intake; and
l The NWIHP will develop a consistent approach to informing women about the risks of
alcohol consumption during pregnancy.
Children and young people
The National Substance Misuse Strategy 9 highlighted the need to expand services for people
under 18 years of age who are experiencing problems as a result of using substances. Most
young people can be treated in the community, but some will need more specialised services,
including residential rehabilitation and detoxification facilities. Many young people with
substance use issues may also be experiencing mental health problems which need to be
addressed as part of their treatment. The Youth Drug and Alcohol Service (YoDA) based in west
Dublin provides assistance and treatment to those under 18 who are having problems related to
their drug or alcohol use. A 2013 study of users of the service 38 found that 48% had a lifetime
history of psychiatric disorders, with deliberate self-harm being the most common condition.

Agency
2.1.20 Expand addiction a) Strenghtening links between DOH HSE

services for pregnant maternity services and addiction
and postnatal women. services;
b) Quantifying the need for
additional residential placements
for pregnant and postnatal
women who need in-patient
treatment for addiction to
drugs and/or alcohol across the
country;
c) Developing services to meet that
need ensuring that such facilities
support the development of the
mother-baby relationship;
d) Providing dedicated support for
pregnant women with alcohol
dependency, including examining
the need to expand the role
of the Drug Liaison Midwife
(DLM) in this regard. Any such
expansion will likely generate
a need to further increase the
number of such midwives;
e) Resourcing the National Women
and Infants Health Programme
(NWIHP) to provide drug liaison
midwives and specialist medical
social workers in all maternity
networks;
f) Supporting maternity hospitals/
units to strengthen their methods
of detecting alcohol abuse and
supporting women to reduce
their intake; and
g) Engaging the NWIHP to develop
a consistent approach to
informing women about the risks
of alcohol consumption during
pregnancy.
Agency
2.1.21 Respond to the needs a) Increasing the range of wrap- HSE DOH,
of women who are around community and DATFs
using drugs and/or residential services equipped to
alcohol in a harmful meet the needs of women who
manner. are using drugs and/or alcohol in
a harmful manner, including those
with children and those who are
pregnant; and
b) Developing interventions to
address gender and cultural
specific risk factors for not taking
up treatment.
2.1.22 Expand the range, a) Identifying and addressing gaps HSE, C&V
availability and in child and adolescent service TUSLA sectors,
geographical spread provision; DATFs
of problem drug and b) Developing multi-disciplinary
alcohol services for child and adolescent teams; and
those under the age of
c) Developing better interagency
18.
cooperation between problem
substance use and child and
family services.
Improving access to services for people with more complex needs

There is a need to recognise the diversity evident among drug users and to take steps in
providing services that can accommodate this diversity and address the needs of particular
groups in relation to problem drug and alcohol use. Specific groups with more complex needs
include:
l Long-term substance users;
l People with co-morbid mental health and substance use problems;
l Members of the Traveller community and other minority ethnic communities;
l Homeless people, people in prison and sex workers; and
l Lesbian, gay, bisexual, transgender and intersex communities.
The HSE is currently examining the most practical, sustainable means of supporting staff
to deliver services in culturally competent ways in consultation with traveller representative
organisations. Cultural competence is defined as the ability of service providers and
organisations to effectively deliver health care services that meet the social, cultural and
linguistic needs of those who use services. Service-delivery staff should uphold fundamental
values and attitudes (such as equality, empathy and engagement) towards all service users.
Long-term substance users

The number of people who are older and availing of treatment for heroin use is increasing 39.
Over 40s comprised 42% of OST clients in 2015, up from 31% of clients in 2013. This cohort
is likely to suffer from negative social consequences of long term drug use such as
unemployment, social exclusion, marginalisation and homelessness. In addition to conditions
associated with the normal aging process they are prone to a range of health-related problems
including dental deterioration, hepatic damage, often exacerbated by excess alcohol use, and
chronic lung, venous and arterial damage. They are also at risk from harm as result of the
interactions between methadone and medications used to treat other diseases.
People with a co-occurring mental health and substance use problem
A recurring theme in the public consultation was a concern about access to services for
people who have a co-occuring mental health and substance use problem, often called “dual
diagnosis”. Ensuring that people with a dual diagnosis receive an assessment, an onward referral
and timely access to appropriate treatment is extremely important. They may be dealing with
the impact of trauma or a psychiatric disorder as well as experiencing problems as a result of
alcohol and/or drug use. These individuals may also have physical and psychological health
problems, disabilities, or problems with housing, employment and relationships or have a
history of offending.
The HSE’s Mental Health Division is working with the Clinical Strategy and Programmes Division
to develop a new Mental Health Clinical Programme called “Dual Diagnosis: mental illness
and co-morbid substance misuse”. The aim of this Programme is to develop a standardised
evidence-based approach to the identification, assessment and treatment of co-morbid mental
illness and substance misuse. This includes increasing awareness of the frequent coexistence of
mental illness and substance misuse; ensuring there is a clear clinical pathway for management
of people with such a dual diagnosis, including when they present to Emergency Departments;
ensuring a standardised service is provided throughout the country; and ensuring adolescents
are also included within the scope of this Clinical Programme.
An integral part of the Dual Diagnosis Programme will be to devise a model of care that will
ensure that all adolescents and adults suspected of having a moderate to severe mental illness
coexisting with significant substance misuse have access to a timely mental health service
delivered on a regional basis. The service will be provided in an integrated manner across
the Primary Care Division and the Mental Health Service. There will also be close working
relationships with the relevant specialities in Acute Hospitals to deal with any medical co-
morbidities that may occur, particularly in those with alcohol misuse.
People who are homeless

People who are homeless are at a far higher risk of problem drug use than people in secure
housing, with particularly high levels of use and risk amongst rough sleepers and those using
emergency accommodation. While substance misuse can lead to homelessness, homelessness
can also contribute to the development of substance misuse problems. This underlines the
importance of homelessness services and substance misuse services working together in a
collaborative way, such as through the nine regional homelessness forums 40. Although a lack
of housing is currently a society-wide issue, providing independent tenancies to homeless
people with appropriate supports offer the best outcomes for individuals that have successfully
completed treatment and rehabilitation.
In Rebuilding Ireland: Action Plan for Housing and Homelessness 41, the Government committed
to a tripling of the target for tenancies to be provided. Housing led/housing first programmes,
which provide for accommodation with supports as required, are internationally considered as
best practice in addressing the needs of people who are long-term homeless and with complex
needs. The success of such initiatives depends not just on housing but also, crucially, on drug
and alcohol, mental health, and community integration services being available.
People in contact with the criminal justice system

Prisoners
Lifetime prevalence of cannabis, cocaine and heroin is at a far higher rate among prisoners than
in the general population and notably female prisoners report higher lifetime and past month
use of heroin and both crack and powder cocaine 42. Between 2009 and 2015, 5,450 cases
received treatment in prison. This represents more than 9% of the total treatment cases in the
country during this period.
There is a range of drug rehabilitation programmes available for prisoners that involve a
significant multidimensional input by a diverse range of general and specialist services
provided both by the Irish Prison Service (IPS) and visiting statutory and non-statutory
organisations 43. The programmes seek to reduce the demand for drugs within the prison
system through education, treatment and rehabilitation services for prisoners with addictions.
Particular initiatives include the provision of detoxification, methadone maintenance, education
programmes, addiction counselling and drug therapy programmes. The delivery of these
services is being achieved in partnership with community-based services and has brought a
significant improvement in the range, quality and availability of drug treatment services in the
prisons.
The IPS continues to work to decrease the availability and use of illicit drugs in the prison
environment. These efforts will need to take into consideration the challenges posed in
responding to the newer drugs of choice, in particular, new psychoactive substances, in
the prison environment. These newer drugs will require more contemporary and advanced
strategies to meet the physical, procedural and related security requirements.
The IPS is committed to providing healthcare, including specialist addiction services, to

those in custody on an equivalent basis to that available to the general population. It remains
important that particular attention continues to be paid to identifying risk factors as a result of
drug use and to providing the necessary drug treatment services to support positive changes
in behaviour. Ensuring that people leaving prison can continue to access treatment in the
community is essential and continues to be one of the key objectives of the National Drugs
People engaged with Probation Service

There is a clear association between substance misuse and offending behaviour. Substance
misuse is harmful to the individual and can lead to an increase in criminal activity, causing harm
and victimisation in communities. Where this is the case, the importance of access to targeted
substance misuse interventions for those subject to criminal justice sanctions in the community,
such as probation supervision, can provide an opportunity to support and effect change in the
lives of these individuals and their communities.
Improving access to services for specific populations

Members of the Travelling community
Poor living conditions and high levels of unemployment and educational disadvantage
contribute to the higher risk of drug and alcohol misuse among members of the Travelling
community. While Travellers represent just over one half per cent of the population, 3.6% of
those treated for problem drug use in 2015 were from the Travelling community 30. Compared
to the general population, the main problem drug reported by Travellers accessing treatment
between 2007 and 2010 was more likely to be opiates (37% vs 29%). During the same period
there was an increase in the number of Travellers seeking treatment for benzodiazepines and
cannabis and this was above the rate of increase in the general population. The prevalence of
main problem drugs were similar for male Travellers as the general population, but amongst
female Travellers, opiates were reported more frequently as the main problem drug.
Although male Travellers entering drug treatment were less likely to have lifetime prevalence
of injecting drug use compared to the general population, female Travellers reported higher
rates of injecting; 24% compared to 16% in the general population. Travellers entering drug
treatment were more likely to report polydrug use, with cannabis the most frequently reported
second problem substance 11. Good practice guidelines, produced on behalf of this community,
provide useful and practical advice on supporting Travellers who need to use treatment
services.
Other groups with complex needs

The LGBTI community are another group which face higher risks of problem substance use.
A recent national study reports that recreational drug use amongst LGBTI is two times higher
than in the general population 44. Over 50% of LGBTI people have taken drugs recreationally,
with cocaine-based drugs and ecstasy being the most common drugs used.
Migrant communities may also experience barriers to accessing services or maintaining

treatment, for a variety of reasons. Marginalised members of society and hard to reach groups
may need targeted interventions, as equality of access does not always result in quality of
participation or of outcomes.

Agency
2.1.23 Improve the response Examining the need for the HSE C&V
to the needs of older development of specialist services to sectors,
people with long term meet the needs of older people with DATFs
substance use issues. long term substance use issues.
2.1.24 Improve outcomes for a) Supporting the new Mental HSE DOH,
people with co-morbid Health Clinical Programme to IPS, C&V
severe mental illness address dual diagnosis; and sectors
and substance misuse b) Developing joint protocols
problems. between mental health services
and drug and alcohol services
with the objective of undertaking
an assessment with integrated
care planning in line with the
National Drug Rehabilitation
Framework.
Agency
2.1.25 In line with Rebuilding a) Increasing the number of HSE C&V

Ireland, improve the detoxification, stabilisation and sectors
range of problem rehabilitation beds;
substance use services b) Providing additional/enhanced HSE LAs, C&V
and rehabilitation assessment, key working, care sectors
supports for people planning and case management.
with high support needs This entails person-centred
who are homeless. holistic care planning, including
identifying and building social
and recovery capital;
c) Ensuring in-reach support during HSE LAs, C&V
treatment and rehabilitation sectors
to prevent homelessness on
discharge to ensure that housing
and supports are in place;
d) Ensuring resourcing and DOH HSE,
enhanced cooperation DHPLG LAs, C&V
arrangements between non- sectors
governmental service providers
and State organisations, involved
in the delivery of addiction
treatment and housing services,
so that the drug rehabilitation
pathway is linked to sustainable
supported housing-led/housing
first tenancy arrangements; and
e) Developing the provision of LAs, HSE DHPLG,
gender and culturally specific DOH,
step down services, particularly C&V
housing, for women and sectors
their children progressing
from residential rehabilitation
treatment who are at risk of
discharge into homelessness.
2.1.26 Intervene early with at a) Providing training to enable IPS, PS AGS,

risk groups in criminal the delivery of screening, brief HSE
justice settings. intervention and onward referral
in line with national screening and
brief intervention protocols for
problem substance use;
b) Further develop the range IPS, PS
of service specific problem
substance use interventions
in line with best international
practice; and
c) Determining the prevalence of IPS HSE
NPS use in prison settings with
a view to developing specific
training for staff and appropriate
interventions.
Agency
2.1.27 Improve the capacity a) Fostering engagement with HSE C&V

of services to representatives of these sectors
accommodate the communities, and/or services
needs of people working with them, as
who use drugs appropriate;
and alcohol from b) Considering the need for
specific communities specialist referral pathways for
including the Traveller specific groups who may not
community; the otherwise attend traditional
lesbian, gay, bisexual, addiction services (i.e. those who
transgender and engage in chemsex);
intersex community;
c) Providing anti-racism, cultural
new communities; sex
competency and equality training
workers and homeless
to service providers; and
people.
d) Ensuring all services engage
in ethnic equality monitoring
by reporting on the nationality,
ethnicity and cultural background
of service users for the NDTRS
and treat related disclosures with
sensitivity.
Objective 2.2: Reduce harm amongst high risk drug users

People who inject drugs (PWID) are a particularly vulnerable population that are susceptible
to harm and need carefully managed supports to enable them attain stability and a safer and
healthier life 11. Infectious diseases are among the most serious health consequences of injecting
drug use. Injecting drug use is one of the main modes of transmission of hepatitis C (HCV)
infection in Ireland. The number of HCV cases reported to the Health Protection Surveillance
Centre (HPSC), where injecting drug use was identified as a risk factor has been declining
since 2010 when 728 such cases were reported. In 2015, 169 such cases were reported 45.
Nevertheless, PWID make up the majority of all cases of HCV in Ireland. Chronic HCV infection
may cause liver cirrhosis, hepatocellular carcinoma and liver failure.
HPSC data show a gradual decline in new cases of HIV amongst PWID from 2005 to 2012.
The number of such cases began to rise in 2013 and continued to rise to 27 cases in 2014.
In 2015, 9% (45) of newly diagnosed HIV cases were PWID. This is the highest number of
new HIV cases among PWID recorded since 2008 45.
Ensuring access to needle exchange, harm-reduction advice promoting sexual health and
screening programmes will continue to play an important role in reducing the risk of contracting
blood-borne viruses such as HCV and HIV. Needle exchanges are provided in counties Dublin,
Kildare and Wicklow by a mix of static and outreach services. The National Pharmacy Needle
Exchange programme provides needle exchange interventions outside of these areas. At the
end of 2016, there were 109 pharmacies participating in this programme 31. An average of 1,330
individuals attended pharmacy-based needle exchanges each month in 2014.
Many respondents in the public consultation highlighted ease of access to prescription

medication, particularly benzodiazepines and so-called z-drugs (zopiclone and zaleplon),
through the internet, with direct delivery to a person’s door. This is reflected in figures for the
last 10 years which indicated an increase in treatment demand relating to benzodiazepines, as
well as a rapid increase in related deaths, in Ireland in comparison to other European countries.
The National Drug Related Deaths Index (NDRDI) indicates that prescription drugs were
implicated in three in every four, or 259, poisoning deaths during 2014. Benzodiazepines were
the most common prescription drug group implicated and diazepam (a benzodiazepine) was
the most common single prescription drug implicated in 115 (32%) of all poisoning deaths in
that period 8.
The illegal trade in so-called z-drugs, has exacerbated the problem particularly among those
who inject drugs. The Minister for Health has amended the Misuse of Drugs Regulations to
tighten controls on benzodiazepines and z-drugs. It will be important to ensure that the health
needs of people, who can no longer gain access to these substances through the illegal drug
market are addressed when such controls are in place.
There is a recognised problem with street injecting in Ireland, particularly in Dublin City
centre. This practice poses a significant health risk for people who use drugs, and results in
discarded needles which presents a public health risk to others. Mounting public concern
and campaigning by harm reduction advocates led to a proposal for the establishment of
supervised injecting facilities (SIF) to ameliorate these problems and the Programme for
Government contains a commitment to legislate for such facilities.
On 16 May the Misuse of Drugs (Supervised Injecting Facilities) Act 2017 (No. 7 of 2017) 46 was
signed by the President having been passed by the Oireachtas on 10 May. The Act will allow for
the licensing and establishment of supervised injecting facilities by the Minister for Health. The
HSE plans to establish the first SIF on a pilot basis in order to determine its utility, safety and
cost effectiveness in an Irish context.
Risk of Overdose and Drug-Related Deaths

The Rapid Expert Review 10 noted that “drug related overdose and other forms of avoidable
mortality associated with drug use has to be a major concern for any future drug strategy as
it is in this area that a large share of the health costs associated with drug use are accrued and
thus also the area where the greatest potential benefits from intervening effectively may be
obtained”.
There is a worrying level of overdose rates in Ireland. 4,256 non-fatal overdose cases, or
poisoning by alcohol and/or other drugs, were recorded as being admitted to Irish hospitals in
2014. This reflected a marginal increase from 4,233 cases in 2013, but trends over time indicate
a decrease from 2005 when there were 5,012 cases 45.
In 2014, the EMCDDA reported the mortality rate due to overdoses (poisonings) in Europe
was estimated at 18.3 deaths per million population for people aged 15–64 47. Estimates for
overdose mortality rates in Ireland are much higher, at 71 per million, the third highest in Europe
after Estonia (113 per million) and Sweden (93 per million). However, caution is required when
interpreting overdose data across the EU for reasons which include systematic under reporting
in some countries and registration processes that result in reporting delays.
According to the latest NDRDI figures available, the total number of drug-related deaths
rose from 505 to 697 over the period 2005 to 2014 inclusive. The NDRDI reports on poisoning
deaths (also known as overdose) which are due to the toxic effect of a drug, or combination
of drugs, and on non-poisonings which are deaths among people who use drugs, as a result
of trauma or medical reasons 8.
Figure 9: Drug Related Deaths in Ireland 2005–2014
800
700
600
500
400
300
200
100
0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Poisonings Non poisonings Total deaths
Source: National Drug-related Deaths Index
Deaths due to non-poisoning increased at a greater rate than poisoning deaths. Deaths due to
poisonings remain a higher proportion of the total: the number of poisoning deaths increasing
from 301 to 354 and non-poisonings deaths from 202 to 342, during the 10 year period. Many
of these deaths are premature; half of all deaths in 2014 involved people aged 39 years or
younger and three in four (523) involved males.
Alcohol was implicated in one in three drug-related deaths and remains the single most
common drug implicated in deaths between 2004 and 2014. 59% of deaths where alcohol
was implicated involved other drugs, mainly opiates. Three deaths per day in 2013 were alcohol
related and one in three self harm cases during 2013 were alcohol related. Alcohol alone
was responsible for 13% of all poisoning deaths.
The risk of overdose or death due to poisoning or fatalities caused by disease, infection or
other effects of drug use is higher among those who inject drugs or those engaged in polydrug
use. Opiates were the main drug implicated in deaths due to overdose. Two thirds of those who
died in 2014 had taken a mixture of drugs. Benzodiazepines were the most common drug group
involved in polydrug deaths.
This points to the need for overdose prevention strategies to reduce the incidence of both fatal
and non-fatal overdose through the provision of targeted preventative responses for cohorts of
the drug using population at higher risk of overdose. This should involve the targeting of known
risk-periods, such as release from prison and leaving drug-treatment.
The piloting of the Naloxone Programme by the HSE between 2015 and 2016 is an example of a
successful measure to reduce overdoses and drug-related deaths among those who use drugs.
The pilot project was supported by voluntary service providers, the Irish Prison Service and the
National Family Support Network. The HSE Service Plan for 2017 includes a commitment to
further expand the Naloxone Programme to other drug users and their families 48. The HSE will
continue to strengthen overdose prevention strategies in the coming years in order to maintain
the focus on reducing drug-related deaths and non-fatal overdoses.
In addition, a clear ongoing association between certain types of non-poisoning deaths and
mental health issues is emerging from the data. This points to a high level of such deaths
involving persons experiencing both drug or alcohol misuse and mental health disorders
(dual diagnosis). There was a 21% increase in deaths due to hanging between 2013 and 2014
and more than two thirds (67%) of people who died as a result of hanging had a history of
mental health illness.
Ireland’s National Strategy to Reduce Suicide “Connecting for Life” sets out a vision of an
Ireland where fewer lives are lost through suicide, and where communities and individuals
are empowered to improve their mental health and well-being 49.
Connecting for Life has seven goals:

1. Better understanding of suicidal behaviour
2. Supporting communities to prevent and respond to suicide behaviour
3. Targeted approaches for those vulnerable to suicide
4. Improved access, consistency and integration of services
5. Safe and high-quality services
6. Reduce access to means
7. Better data and research
This Strategy is being led by the Department of Health and involves actions assigned to the
HSE, various Government departments and key statutory and non-statutory agencies in Ireland.
Responsibility for monitoring and reporting systems to support the delivery of the Strategy
has been assigned to the National Office for Suicide Prevention. The Strategy provides an
implementation and evaluation structure to achieve each of the goals it proposes, with defined
actions and a lead agency and key partners in place for each individual objective. It also has a
strong partnership dimension, and aims for the coordination and implementation of the relevant
goals and actions to generate outcomes which may not otherwise be achievable by bodies
working in isolation.

Agency
2.2.28 Continue to expand a) Expanding needle exchange HSE C&V sectors

Harm Reduction programmes;
Initiatives focused b) Increasing the availability
on people who inject of screening and treatment
drugs. for blood borne viruses and
communicable diseases; and
c) Increasing the uptake of Hepatitis
C treatment.
2.2.29 Provide enhanced Establishing a pilot supervised HSE DOH,

clinical support to injecting facility and evaluating UISCE,
people who inject the effectiveness of the initiative. Dublin City
drugs and mitigate Council,
the issue of public Relevant
injecting. Local
Authorities,
C&V sectors
Agency
2.2.30 Continue to target a a) Finalising HSE-led Overdose HSE DOH

reduction in drug- Prevention Strategy with a
related deaths and particular focus on implementing
non-fatal overdoses. preventative measures to target
high-risk cohorts of the drug-
using population and known
overdose risk periods;
b) Expanding the availability of HSE C&V
Naloxone to people who use sectors,
drugs, their peers, and family UISCE,
members; NFSN,
DATFs
c) Developing synergies between DOH
Reducing Harm, Supporting
Recovery and other relevant
strategies and frameworks
in particular “Connecting for
Life” whose primary aim is
to reduce suicide rates in the
whole population and amongst
specified priority groups; and
d) Providing suicide prevention HSE HSE
training to staff working with DOH
young people in the area of
alcohol and substance use, in line
with Connecting for Life.
Performance Indicators related to Goal 2

l % of problem drug users accessing treatment within 1 month of assessment (HSE figures).
l % of problem drug users aged under 18 accessing treatment within 1 week of assessment
(HSE figures).
l Mental Health Clinical Programme on Dual Diagnosis and Joint Protocols between Mental
Health services and Drug and Alcohol services in place (HSE figures).
l % of successful exits from treatment in a given year (NDTRS).
l % of problem substance users who have an agreed care plan (HSE figures).
l Number of people who received NDRF training (HSE figures).
l Reduction in the number of drug-related poisonings by 2020, as compared with 2016,
based on latest data available in the reference period (NDRDI).
l Reduction in the number of deaths where opiates are implicated (NDRDI).
CHAPTER 5 – Goal 3: Address the harms
of drug markets and reduce access to
drugs for harmful use
Objective 3.1: Provide a comprehensive and responsive
misuse of drugs control framework which ensures the
proper control, management and regulation of the
supply of drugs
Protecting the public from dangerous or potentially dangerous and harmful substances,
while facilitating the safe use of certain controlled substances, which though harmful if misused,
have medical and therapeutic value, is a core objective of Ireland’s drug control framework.
In line with our obligations under the international UN conventions, Ireland adopts a balanced
approach to the drug problem, based on protecting public health, while engaging in national
and international cooperation aimed at combating transnational organised crime and drug
trafficking.
Ireland’s law enforcement agencies play a vital role in enforcing drug laws and in the national
effort to stem the flow of potentially harmful substances entering the illegal drug market.
An Garda Síochána, Revenue’s Customs Service, the Naval Service and the Health Products
Regulatory Authority work together to protect public health and safety from the harms of
the illegal drug market.
Ireland’s misuse of drugs legislation provides for different levels of control of substances based
on their health risk, potential for misuse and validity of legitimate use. Under Irish legislation,
unless expressly allowed to do so, it is illegal to possess, supply, manufacture, import or export
a controlled substance. Precursor chemicals which can be used in the illegal manufacture of
narcotic drugs and psychoactive substances are controlled through an EU legislative framework.
The Misuse of Drugs legislation provides for criminal offences and penalties for these offences,
including possession of drugs for personal use. There is a need to keep this legislation under
review to respond to the changing drugs situation.
2016 was a significant year in the evolution of global policy on the drug problem. The UN
General Assembly convened a special session on drugs in New York in April 2016 50. This
conference was an important milestone in achieving the goals set out in the 2009 Political
Declaration and Plan of Action on International Cooperation towards an integrated and
balanced strategy to counter the world drug problem.
Ireland participated at UNGASS as a member state of the EU and supported the key strategic
position of the EU on drugs policy, which welcomes a steady transition towards a more
balanced global approach that includes aspects of public health based policies, while continuing
to pursue efforts to counter transnational organised crime and drug trafficking.
New Psychoactive Substances (NPS)

The increased availability of new psychoactive substances (NPS) has been a matter of public
concern over the past decade. From 2007/08 onwards, there was a proliferation of headshops
in Ireland selling a wide range of substances which, while not then illegal under the Misuse of
Drugs Acts, were presenting potential serious health risks for users. Many of these products,
although often marketed as bath salts or plant food and not for human consumption, were
clearly being sold for the purposes of being consumed for drug-like effects.
In tandem with education and awareness measures, the Government initiated a multi-pronged
approach to targeting the activities of head shops and the sale of unregulated psychoactive
substances and there were related actions in the 2009-2016 strategy 2.
In May 2010, the Government made an order declaring approximately 200 psychoactive
substances to be controlled drugs for the purposes of the Misuse of Drugs Acts and the
Minister for Health introduced the necessary regulations to control these substances. These
instruments, which made the possession and supply of the substances concerned subject to
criminal sanctions under the Misuse of Drugs Acts, covered most substances then commonly
being sold in head shops. Since that time, more than 260 NPS have been controlled under
Misuse of Drugs regulation.
Experience has shown that new psychoactive substances can quickly emerge and there will
always be a time lag before such new substances can be made subject to control under the
Misuse of Drugs Acts. For that reason, the Government also decided in May 2010 to introduce
the Criminal Justice (Psychoactive Substances) Bill as a general criminal justice measure to deal
with new psychoactive substances as they emerge on the drug market. The Bill was drafted as
a matter of priority and was signed into law on 14 July 2010. The Act 5 came into operation on
23 August 2010.
The Criminal Justice (Psychoactive Substances) Act 2010 5 makes it a criminal offence to sell,
import or export, for human consumption, a psychoactive substance which is not regulated or
controlled under other legislation.
Drug Driving
Driving under the influence of drugs is a problem in Ireland, as it can impair ability to drive.
The Medical Bureau of Road Safety (MBRS) found that out of the 9,734 specimens of blood
and urine tested for the presence of a drug or drugs between the years 2009 and 2015, 6,232
or 64% tested positive 51. The Road Traffic Act 2016 64 gives An Garda Síochána new powers
to test drivers for drugs at the roadside and in Garda stations. Current provisions for Mandatory
Alcohol Testing (MAT) checkpoints will be extended to provide for Mandatory Intoxication
Testing (MIT) checkpoints testing drivers for both alcohol and drugs. The new measures
commenced on 13th April 2017. The Road Safety Authority has recently launched a campaign
to increase awareness of the new measures which will include an ad campaign, a social media
campaign and updated leaflets on drugs and driving and taking medicines while driving.
Strategic Review of Penal Policy

The Final Report of the Working Group on a Strategic Review of Penal Policy of July 2014 52
contains recommendations in relation to the extension of Restorative Justice Programmes,
the Adult Caution Scheme and Mandatory Minimum Sentencing. This report, which is currently
being implemented, will deal with criminal behaviour including drug offending behaviour.
Developments in relation to the implementation of the report will be monitored under the
new strategy.
An inter-agency Working Group on Alternatives to Prosecution was established by the Criminal

Justice Strategic Committee (CJSC) on foot of separate recommendations from the Penal
Policy Review and the Garda Inspectorate that consideration be given to extending the scope
of the Adult Caution Scheme. The Inspectorate had further recommended that drug possession
offences be specifically considered for inclusion in this Scheme. In its final report to the CJSC,
the Working Group recommended (inter alia) the extension of the Scheme to encompass
first-time offences involving possession of a controlled substance for personal use (‘simple
possession’). This recommendation is currently under consideration by the relevant authorities
and a decision is expected shortly.
Spent Convictions
The Criminal Justice (Spent Convictions and Certain Disclosures) Act 2016 65 provides for
certain convictions to become spent once 7 years has passed since the date of conviction.
The purpose of the legislation is to provide that persons who have made a mistake by
committing a minor offence in the past and paid the price, can move on with their lives after
the appropriate time and will not be held back. In accordance with the provisions of the Act
the following convictions will be spent:
l All convictions in the District Court for motoring offences which are more than 7 years
old will be spent, with the proviso that spent convictions for dangerous driving are limited
to a single conviction.
l All convictions in the District Court for minor public order offences which are more than
7 years old will be spent.
l In addition, where a person has one, and only one, conviction (other than a motoring
or public order offence) which resulted in a term of imprisonment of less than 12 months
(or a fine) that conviction will also be spent after 7 years. This provision will apply to
either a District Court or Circuit Court conviction.
It should be noted that serious offences, including most importantly criminal actions directed
against children and vulnerable persons, are not within the scope of the Act.
The Act was commenced in full on 29th April 2016. The Steering Committee is of the view that
the operation of the Act should be reviewed after a period in operation to ensure that pathways
to rehabilitation and a normal life for those who have committed offences during a period of
drug use are not unduly affected by the system of recording of convictions. It was noted by the
Steering Committee that the Act will be liable for post-enactment scrutiny at the discretion of
the Justice & Equality Committee under the new Dáil procedures.
Sanction Options
Within the Criminal Justice System there are a range of options available to the Court in
dealing with those who have committed a criminal offence. The legislature generally sets the
maximum sentence that can be imposed within the drugs legislation and it is then a matter for
the judiciary to decide what is the appropriate sentence in a particular case taking into account
all the circumstances surrounding the crime and the individual offender. The range of options
available to the Court in dealing with drug offences can include fines, custody, imposition of a
Peace Bond/Probation Order, suspended sentence etc.
Drug Treatment Court

Ireland also provides for a drugs treatment court to assist offenders with drug related
problems. District Courts may refer cases to the Drugs Treatment Court. These cases are in
the first instance assessed for participation by the Probation Service and subject to suitability/
motivation, their progress will be monitored by the Drugs Treatment Court and monitored/
supported through an interagency model. The focus of this intervention is on addressing the
substance misuse issues and thereby supporting the offender desist from crime reducing the
likelihood of further offending. The process is diversionary and can prevent progression to
conviction for those referred. It was noted that this intervention is cross-cutting, involving an
alternative to imprisonment and referral to treatment and education interventions.
The Minister for Justice and Equality is examining options as a way forward for the operation
of the Drug Treatment Court. The matter will be progressed alongside wider justice reforms
that are also under consideration, such as the proposal to establish a Community Court.
An independent review of the Drug Treatment Court could inform the Minister’s deliberations,
and the initiative should continue to be supported in the meantime.
Community Justice Intervention
It should also be noted that a working group within the Justice Sector has been examining
proposals for the development of a ‘Community Justice Intervention’ initiative aimed at tackling
low level adult offenders (i.e. those committing relatively minor offences in specific offence
categories) and effectively addressing their offending behaviour. This would be a diversion
from the courts system and would have the potential to respond more effectively to one-off
and repeat, low level offending with the emphasis on speedy processing aimed at reducing the
risk of re-offending and also to provide quick referral to the necessary services for those that
need them. This work is at the very early stages and is on-going.
Alternative sanctions for Drug Possession

Many people who use drugs problematically, come into contact with the criminal justice system
and acquire criminal convictions, either directly or indirectly related to their drug use. Criminal
convictions can represent a serious impediment for people seeking to move on from drug
misuse and involvement in crime, particularly in the areas of access to employment, housing
and travel.
It is worth noting that “UNGASS 2016” encouraged the development of “alternative or additional
measures with regard to conviction or punishment in cases of an appropriate nature, in
accordance with the three international drug control conventions” 50.
In June 2015, a joint parliamentary committee on Justice, Defence and Equality visited Portugal
and discussed the approach to drug addiction adopted there since 2001. It was reported that
the approach in Portugal has had a very positive result for the communities concerned and is
therapy-based rather than punitive. Under this system, people found in possession of drugs are
brought in front of a commission made up of a social worker, a psychiatrist and a lawyer.
Following the visit and subsequent public hearings, the Committee concluded that a health-led
approach may be more effective and more appropriate for those found in possession of a small
amount of illegal drugs for personal use, rather than a criminal sanction.
The Committee’s report recommended that the possession of a small amount of illegal drugs
for personal use, could be dealt with by way of a civil or administrative response rather than via
the criminal justice route. It also highlighted the need for research to ensure that the adoption
of any alternative approach would be appropriate in the Irish context.
There is a need to explore the approaches taken in other jurisdictions to the possession of small
quantities of drugs for personal use in light of the recommendations in the report. This should
include a review of the current legislative regime in Ireland that applies to simple possession
offences and the rationale underpinning this approach.

Agency
3.1.31 Keep legislation Keep legislation under review, against DOH, AGS,
up-to-date to deal the background of national, EU and DJE Revenue’s
with emerging broader international experiences and Customs
trends in the drugs best practice, to deal with emerging Service,
situation. trends, including: HPRA
a) new synthetic substances;
b) new or changed uses of
psychoactive substances; and
c) the evolving situation with regard
to drug precursors and the surface
web and dark net drug markets.
Agency
3.1.32 Reduce rates of Implementing the measures relating DTTAS

driving under the to the testing of drivers for drugs and
influence of drugs. alcohol contained in the Road Traffic
Act 2016.
3.1.33 Reduce drug Implementing the recommendations of DJE

offending the Final Report of the Working Group
behaviour on a Strategic Review of Penal Policy
and promote of July 2014 relating to drug-offending
rehabilitation. behaviours.
3.1.34 Map the future a) Carrying out an independent DJE

direction and evaluation of the Drug Treatment
objectives of the Court; and
Drug Treatment b) Continuing to support the
Court. operation of the Drug Treatment
Court, having regard to the
recommendations made in the
2013 review 53, pending the
outcome of the evaluation.
3.1.35 Consider the Establishing a Working Group to DOH, AGS, Relevant

approaches consider the approaches taken in DJE Departments
taken in other other jurisdictions to the possession of (Joint) and agencies
jurisdictions to small quantities of drugs for personal
the possession of use in light of the Report of the Joint
small quantities Committee on Justice, Defence and
of drugs for Equality on a Harm Reducing and
personal use with Rehabilitative approach to possession
a view to making of small amounts of illegal drugs to
recommendations examine:
on policy options a) the current legislative regime
to the relevant that applies to simple possession
Minister within 12 offences in this jurisdiction and
months. the rationale underpinning this
approach, and any evidence of its
effectiveness;
b) the approaches and experiences in
other jurisdictions to dealing with
simple possession offences;
c) the advantages and disadvantages,
as well as the potential impact
and outcomes of any alternative
approaches to the current system
for the individual, the family and
society, as well as for the criminal
justice system and the health
system;
d) the identification of the scope of
any legislative changes necessary
to introduce alternative options
to criminal sanctions for those
offences;
e) a cost benefit analysis of
alternative approaches to criminal
sanctions for simple possession
offences; and
f) make recommendations to the
relevant Minister within twelve
months.
Objective 3.2: Implement effective law enforcement
and supply reduction strategies and actions to prevent,
disrupt or otherwise reduce the availability of illicit drugs
Law enforcement is increasingly faced by a more joined up and globalised drug market.
Drug trafficking groups increasingly exploit the opportunities that this presents, which can
include the growth in container traffic and parcel delivery services. Organised crime groups
increasingly establish operational links between countries, or to operate on a transnational basis.
Demographic changes in Europe also mean that crime organisations can exploit the existence
of new migrant communities resulting in the need for law enforcement to identify and target
new organisations becoming active on their territories.
The increased prevalence of cannabis cultivation facilities has led to a shift in the market, with
domestically produced high potency herbal products becoming more available and displacing
imported resin. The growth of the cannabis market in Ireland is associated with increased levels
of criminality, including drug-related intimidation and violence.
The evolution and spread of NPS continues to be a persistent threat, with the injecting of
synthetic high potency opioids resulting in harmful consequences for vulnerable users, such
as the risk of contracting blood-borne viruses.
Significant law enforcement efforts have been invested in intercepting drugs destined for
the Irish market. International operations spearheaded by law enforcement agencies have
resulted in significant seizures and the disruption of organised crime networks involved in
the importation, distribution and sale of illegal drugs in this country.
Ireland participates in international drug fora at EU, Council of Europe and UN level, as
part of the international effort to counter the world drug problem. An Garda Síochána,
Revenue’s Customs Service and the Naval Service actively work with partners at EU and other
international levels to intercept drugs, and precursors for diversion to the manufacture of drugs,
being trafficked to Ireland. National and international cooperation between law enforcement
agencies and other bodies, including those involved in identifying and confisgating the
proceeds of crime, will continue to be strengthened through the international mechanisms
for cross border cooperation.
The expansion of online markets for drugs, mentioned above, represents a new and potentially
growing challenge, as do changes in synthetic drug and cannabis production. The internet
facilitates movement of products, money and information across global borders. Medicines
and other substances, including controlled drugs, can be sourced through the dark net and the
surface net. When a website selling psychoactive substances is taken down, it is replaced by
other websites, almost immediately. Capacity building measures will be necessary to provide
the technical support and know-how to enable law enforcement agencies to effectively monitor
online drug markets and prevent their use as a means of trafficking illegal drugs and other
substances into Ireland.
In line with the Garda Síochána Strategy Statement 2016-2018 54, and supported by the
Garda Síochána Modernisation and Renewal Programme for the period 2016-2021 55, An Garda
Síochána will continue to confront drug related crime utilising intelligence-led operations and
multi-disciplinary approaches to targeting organised crime groups and individuals involved in
crime.
An Garda Síochána has recently strengthened its response to organised criminality including
drug crime through the establishment in 2016 of a consolidated Garda National Drugs and
Organised Crime Bureau (GNDOCB). The GNDOCB works closely with other specialist National
Garda Units including the newly established Special Crime Task Force and with local Garda
Divisions in targeting persons involved in drug related criminality.
Multi-disciplinary approaches will continue to be utilised to ensure the activities of individuals

and groups involved in criminal enterprise are effectively targeted, including the use of the
proceeds of crime legislation, money-laundering legislation and the powers of the Criminal
Assets Bureau (CAB). The GNDOCB works closely with the CAB in a collaborative approach
to ‘follow the money’ and target proceeds of crime.
Recognising the importance of this approach An Garda Síochána is committed to

strengthening the role played by Divisional Asset Profilers in working with the CAB so as to
target the proceeds of crime at local level, including proceeds of crime generated by low and
mid level criminals.
Community Impact Statements (CIS) are used in the criminal justice system in the UK to
provide relevant and useful additional information about the impact crime or a particular
incident is having on a particular community. A CIS is a statement compiled with the authority
of a Police Force in active partnership with the community and other stakeholders, describing
the impact of anti-social-behaviour on a specific neighbourhood or identifiable group of people.
The intention is to enable better informed decisions that are made with the knowledge of the
local context and can be used throughout the justice system.
In order for CIS to be used in the Criminal Justice system in Ireland, legislation would be
required. The Group noted that the Garda Inspectorate Report on Crime Investigation
recommends that An Garda Síochána, in consultation with the Director of Public Prosecutions,
should consider the use of CIS in the Criminal Justice system in Ireland. In addition the Group
noted that the Garda Commissioner has set up a group to examine the recommendations of
the Garda Inspectorate Report 2014 56, which refer to the use of Community Impact Statements
in Ireland.

Agency
3.2.36 Support the role of law Investing in capacity building AGS, DOH,
enforcement authorities measures to support the role Revenue DJE,
in monitoring drug of law enforcement authorities Custom’s HPRA
markets, in particular in monitoring drug markets, in Service
new drug markets, particular new drug markets, surface
surface web and web and darknet drug markets.
darknet drug markets.
3.2.37 Consider the case for Subject to the completion of the AGS
the use of Community Garda examination of Community
Impact Statements Impact Statements, bringing
within the Criminal forward recommendations on their
Justice System in implementation.
Ireland.
Objective 3.3: Develop effective monitoring and
responses to evolving trends, public health threats
and the emergence of new drug markets
Ireland’s Early Warning and Emerging Trends committee is chaired by the Department of Health.
This committee is currently the forum through which information from national and EU sources
on new psychoactive substances (NPS) of concern is received and shared, in the context of
Council Decision 2005/387/JHA on information exchange, risk assessment and control of new
psychoactive substances.
One of the major challenges facing Customs Administrations and Law Enforcement agencies
in general is the ability to rapidly and easily identify NPS when encountered. This task is made
more difficult by the wide range and complexity of products available on the market, together
with the tendency for manufacturing chemists to make frequent, and often minor, changes to
composition which takes them outside the analytical capability of available frontline technology.
A lack of international research on the composition and effects of NPS can hamper efforts to
place controls on such substances and provide expert testimony in court cases involving the
sale or supply of NPS.
Reporting and analysis

Monitoring work also includes the reporting and analysis of data relating to the distribution
and sale of controlled substances and the scientific analysis of drugs seized. The latter
is particularly important with regard to NPS. The range and complexity of NPS and the
unpredictable, sometimes catastrophic, nature of their effect on the user requires a closely
integrated early warning system that can respond to incidences and report accurately and
quickly. This system facilitates communication between a range of information sources in
health and law enforcement agencies, laboratories and government departments.
Monitoring NPS presents challenges to laboratories and there is a need to develop analytical
capacity, data collection and public warning mechanisms. It is essential to avoid inaccurate
communication around high profile drug ingestions and laboratories need to develop the
analytical protocols for accurate identifications of substances and distinguish between
analogues with only tiny variations.
Government recognises the importance of developing the analytical capacity of the laboratories
involved in identifying substances, and has made a commitment to provide funding in the
capital expenditure programme for the construction of a purpose built new laboratory for
Forensic Science Ireland (FSI), with €6m prioritised to enable the commencement of building
work two years earlier than originally scheduled.
Presumptive Drug Testing

Presumptive Drug Testing (PDT) was introduced in February 2011 It is limited to Section 3
(personal possession) cases involving Cannabis, Cannabis Resin or Cocaine where the suspect
admits that the substance is one of these drugs and that it is for his or her immediate personal
use. PDT was introduced to reduce the number of Section 3 cases being submitted to FSI
for analysis so as to permit it to focus its analytical resources on Section 15 (dealing) cases.
However, the system has had only limited success. The principal reason for this is legal issues,
which arise in the District Courts. The matter continues to be examined by the Working Group
to Identify and Report on Efficiencies in the Criminal Justice System/Circuit and District Court.
Agency
3.3.38 Strengthen the a) Continuing to develop systems DOH HSE, HRB, FSI,
response to to monitor changing drug State Lab, MBRS
the illegal drug trends in line with the EU Early AGS
market, including Warning System;
the changing b) Completing the development HSE DOH, HSE, DJE
nature of new of the HSE public alert system
psychoactive for adverse events due to
substances. drugs and commencing
implementation;
c) Supporting government DPER,
funded laboratories, tasked DTTAS
with analysis of drugs of abuse,
to engage in novel analytical
development work, in relation
to psychoactive drugs but
especially new psychoactive
substances (licit or illicit), while
continuing to fulfil their core
functions;
d) Providing funding in the capital DJE
expenditure programme for the
construction of a purpose built
new laboratory for Forensic
Science Ireland with €6m
prioritised to commence the
project immediately; and
e) Strengthen the legal robustness
of Presumptive Drug Testing
(PDT) to contribute to the
timely prosecution of Section
(3) drug-related offences.
Performance indicators related to Goal 3

l Participation of relevant sectors and experts in the Early Warning and Emerging Trends
Sub-Committee (DoH).
l Timely and coherent response to adverse incidents (HSE figures).
l The volume of drugs seized that are considered to be intended for the Irish market
(AGS/Revenue’s Customs data).
l Number of prosecutions for importation, manufacture and distribution of illicit drugs
(Recorded Crime Offences).
l The number of supply detection cases (Recorded Crime Offences).
CHAPTER 6 – Goal 4: Support
participation of individuals, families
and communities
Objective 4.1: Strengthen the resilience of communities
and build their capacity to respond
Promoting community participation and involvement
Building the resilience of communities to respond to the drug problem is a key feature of
Ireland’s drugs policy. It recognises the importance of enabling communities to participate
in shaping the decisions that affect them, through providing opportunities for meaningful
participation and engagement in policy development and decision-making.
There are a great variety of community and voluntary organisations in Ireland whose knowledge
of local concerns and commitment to their own area helps to build a community’s capacity to
respond to these concerns with flexibility and sensitivity. Such organisations play a valuable
role in promoting positive social change, in partnership with the local communities and
communities of interest they serve.
Supporting social connectedness and involvement in community life are key to empowering
people at the individual level and building strong communities for health and wellbeing.
This approach is a core theme of the Healthy Ireland Framework, which states that building
awareness of and action on the social determinants of health will assist communities to
organise and mobilise their response to the challenges that affect health and wellbeing
within their own communities.
Community organisations working in disadvantaged areas give a voice to the most marginalised
and build the capacity of individuals, families and communities to organise and participate
in decision-making around the issues that affect them. Prevalence of poor health and social
problems is markedly higher in those communities with the greatest levels of deprivation.
These are the communities most susceptible to consequences of problem drug use.
Understanding the underlying socio-economic and cultural factors which contribute to the
drug problem has resulted in the development of an integrated whole-of-government response
based on a partnership approach between the statutory, community and voluntary sectors. As
key stakeholders in addressing the drug problem, it is crucial that communities are supported to
effectively participate in partnership structures at local, regional and national level. The need for
improved coordination in service provision and to utilise the knowledge and experience of local
communities in designing and delivering those services led to the establishment of Local Drugs
Task Forces (LDTFs) in areas with the highest prevalence of problem drug use. Regional Drugs
Task Forces (RDTFs) were later established to complement this effort in the parts of the country
not covered by the LDTFs. They have been key to the development of practical services such
as treatment and rehabilitation facilities through supporting and funding local initiatives. Task
Forces have also played a key role in harnessing the efforts of community groups, families and
local residents and have built partnerships with statutory services and local representatives.
Local Community Development Committees (LCDCs) are responsible for directing SICAP
funding to those areas that are most socially disadvantaged, in accordance with the needs
and priorities identified in the Local Economic and Community Plans and the County
Development Plans informed by the key demographics for each area. There is potential for
LCDCs to improve their links with Task Forces over time. SICAP’s vision is to improve the
life chances and opportunities of those who are marginalised in society, living in poverty
or in unemployment, through community development approaches, targeted supports and
interagency collaboration. SICAP Programme Implementers actively encourage the engagement
and participation of disadvantaged individuals and marginalised communities in local
development and supports them to enhance their participation in local, regional and national
decision-making structures.
Participation in key decision-making structures, whether local councils or structures within

Public Participation Networks (PPNs), allows SICAP target groups to affect change in their
locality, increase their sense of empowerment and ultimately to improve their wellbeing. Whilst
operating within a national programme framework, the programme affords sufficient local
flexibility to Programme Implementers to be able to respond to local priorities as individual
communities throughout the country have particular needs and circumstances may differ
considerably between them.
Initially established in response to a largely heroin problem, Task Forces have had to adapt
to an evolving drug situation. During the period of the current strategy, cannabis has become
the main problem drug for young people presenting to treatment services for the first time.
Polydrug use, misuse of prescription medication and new psychoactive substances present
new challenges to the overall health and security of communities. Alcohol misuse, particularly
in combination with other forms of problem drug use, presents particular difficulties in
marginalised communities. In recognition of the scale of the difficulties associated with alcohol,
and of the potential of community mobilisation in responding to it, the task forces were
renamed Drug and Alcohol Task Forces (DATFs) in 2012.
Targeting communities affected by the drug problem

The consequences of substance misuse affect different communities disproportionately. The
analysis provided in the Performance Measurement Framework for Drug and Alcohol Task
Forces confirms that there is a close connection between the level of problem substance use
and levels of deprivation and other adverse social conditions in urban areas. The relevance of
the Framework to improved targeting of resources on the basis of social need and reducing
the negative impact of socio-economic disparities is outlined in more detail in Chapter 8 of
this report.
There are a number of data sources available that can be used both to identify risk factors
in a particular area and assess the impact of efforts to strengthen protective factors. Using
information on the prevalence of opiate use and other high risk drug use we can identify the
areas most affected. Drug-related deaths information from communities most affected by the
fatal consequences of substance misuse help to establish the link between social and economic
determinants and drug-related mortality.
It can be difficult to assess the real impact of drug markets and other illegal activity on a
community, even when the consequences of these activities are very apparent to the people
living there. One approach might be to identify indicators, derived from health, law enforcement
and other monitoring systems, that can be used to measure the effects of high level problem
drug use, and the crime and antisocial behaviour associated with it, within a defined area.
Analysis using these indicators could provide valuable information to a community preparing
and evaluating a response to these problems.
Criminal activity and an active illicit drug market can create an intimidating and frightening
environment in an affected community. The concentration of illicit drug markets in particular
areas means that already marginalised communities must also deal with social and public
disorder and property crime associated with the sale and distribution of drugs. The use of
violence or the threat of violence to enforce debts further impacts on these communities by
creating an atmosphere of fear and undermining the health and wellbeing of families affected
and the wider community.
The National Drug-Related Intimidation Reporting programme, developed by the National
Family Support Network and An Garda Síochána, provides a framework to allow reporting of
an incident of intimidation to a nominated inspector. Further development of the community
approach to this problem will need to be informed by evaluations of these and other initiatives
being undertaken in a number of taskforce areas. A review by the HRB of the international
literature on gang prevention, desistence from gangs and criminal and legal interventions to
counter gang activity, will be useful in informing the development of a collaborative response
to intimidation involving law enforcement agencies, social services, schools and community
organisations 57.
The task of building safer, more resilient communities will be helped by the type of cooperation
and mutual support between An Garda Síochána and community representatives that has
been established during the period of the first two drug strategies. An Garda Síochána
representatives sit on task forces, and mechanisms such as Local Policing Fora help to build
important intra-sectoral relationships within communities.
Joint Policing Committees, facilitate the important work of consultation and cooperation
between An Garda Síochána, local authority officials and community representatives on which
effective community policing depends. In line with the Garda Síochána Strategy Statement
2016-2018 54 and the 2017 Crime Prevention and Reduction Strategy 58, and supported by the
Garda Síochána Modernisation and Renewal Programme 2016-2021 55, An Garda Síochána is
continuing to promote and embed a new community policing ethos across An Garda Síochána
to enhance trust and confidence and to ensure a visible, accessible and responsive service and
implement a suite of customised crime prevention approaches to protect communities from
crime.
A range of initiatives designed to deliver on strategic commitments will include strengthened

community engagement through the Community Policing Teams and Community Safety
Fora so as to identify neighbourhood issues impacting on the quality of life and the measures
needed to address them. As part of the crime prevention through partnership response
An Garda Síochána is also committed to designing and implementing a revised approach to
offender management including youth offenders and recidivist offenders in the community
through inter-agency partnerships.
Recognising the harm caused by drug-related debt intimidation, An Garda Síochána will
carry out an evaluation of the Drug-Related Intimidation Reporting Programme to strengthen
its effectiveness and to identify further opportunities to build on that work through Community
Safety Fora and the creation of linkages with community policing and the asset profiling
programme. The National Family Support Network, who have worked with An Garda Síochána
to build support for this programme, will also carry out their own evaluation from the
perspective of their network. These reviews will further inform development of the reporting
programme by An Garda Síochána and The National Family Support Network.
The depth of experience and knowledge built up by the community sector in responding
to this situation will be an immensely valuable resource to this strategy.
Agency
4.1.39 Support and Supporting and promoting DOH Community

promote community community participation in all local, Sector, LAs,
participation in all regional and national structures. DHPLG,
local, regional and DATFs
national structures.
4.1.40 Measure the Developing and piloting a Community C&V

impact of drug- Impact Assessment Tool in order to sectors
related crime measure the impact of drug-related
and wider public crime and wider public nuisance
nuisance issues on issues on communities.
communities.
4.1.41 Enhance the Building on the achievements of DJE,

relationship Local Policing Fora in providing an DHPLG,
between an Garda effective mechanism for building and AGS
Síochána and maintaining relationships between
local communities an Garda Síochána and the local
in relation to the communities, in particular in relation
impact of the drugs to the impact of the drugs trade.
trade.
4.1.42 Strengthen the An Garda Síochána and the National AGS,

effectiveness of Family Support Network will each NFSN
the Drug-Related carry out its own evaluation of the
Intimidation Drug-Related Intimidation Reporting
Reporting Programme to strengthen its
Programme. effectiveness and, if appropriate,
develop measures to raise public
awareness of the programme.
Objective 4.2: Enable participation of both users

of services and their families
As important stakeholders, service users and their families have a key role to play in
contributing to the planning, design and delivery of effective services. Service users, because
of their direct experiences of services, have unique insights which are a valuable resource to
those involved in developing services and interventions. Facilitating their involvement in the
development and design of services is therefore a core objective of drugs policy.
The term ‘service user’ includes people who use health and social care services and their
families. It also includes people who are potential users of health services and social care
interventions, including people who use drugs, who may not yet have availed of treatment.
All HSE and HSE funded addiction services in primary care are expected to work within
the National Standards for Safer Better Health Care 59. These standards reflect many of the
elements that have been outlined within this Reducing Harm, Supporting Recovery, such as
the importance of person-centred care and ensuring that service users’ needs and preferences
inform the planning, design and delivery of services.
Service user involvement is about facilitating people to become meaningfully involved in
defining the issues of concern to them, in making decisions about factors that affect their lives,
in formulating policies and in planning, developing and delivering services, and in taking action
to achieve change.
Involvement in their own care or treatment plan

People who use services should have the opportunity to make informed decisions about their
care and treatment, in partnership with their healthcare professional, including setting their own
treatment and recovery goals. Good communication and the provision of adequate information
is key to ensuring that people who use services are enabled to make informed decisions
about their care, including informed decision-making to give or refuse consent to treatment.
A key worker should be assigned to work closely with the service user to facilitate his or her
participation in the care planning process, including the setting of treatment goals.
Patient safety and quality is one of the four core elements of the recently adopted HSE
Accountability Framework. In addition, health professionals are guided by their codes of ethical
and professional conduct. Assurance of patient safety requires active leadership, governance
and clinical commitment to quality. Each substance misuse service should have a defined
patient safety and quality operating framework to address service user advocacy, complaints
and learning procedures, incident management and response, and substance misuse quality
elements such as standards, guidelines, audit and performance indicators in order to foster
a patient safety culture.
Peer-led services can support person-centred care, by providing social support to the individual
during and after treatment.
Involvement in improving service delivery

In addition to being involved in their own care, service users should be enabled to participate in
the development of local services. Services should provide service users with the opportunity
to provide constructive feedback on both positive and negative experiences of attending the
service. This may include suggestions about how to improve the service they are attending,
participate in activities to facilitate feedback and discussion. This can be achieved through a
variety of methods such as questionnaires, suggestion boxes, and regular meetings and can
be on a one-to-one and/or group basis. The HSE plans to undertake a service user experience
survey and to subsequently address the findings.
Involvement in decision-making structures

Service users should also be facilitated to participate in the local, regional and national decision-
making structures of the strategy. Service users also have an important role to play in ensuring
that the design and delivery of drug and alcohol treatment services meets the needs of those
with drug or alcohol problems. Organisations, networks and advocates provide a platform for
service users to voice their concerns and ensure that there is meaningful engagement at all
levels. The consultation process for this strategy involved substantial engagement with service
users across the country and networks of people who use drugs and services and their families
were involved in the Steering Committee tasked with developing proposals for the new strategy.
Support for independent representation for those who use drugs, as well as those who are
using services, is recognised good practice for enabling advocacy and improving outcomes.
Agency
4.2.43 Build capacity within drug Requiring the delivery DOH HSE
and alcohol services to of services within a
develop a patient safety Quality Assurance
approach in line with the Framework, which will
HIQA National Standards a) standardise
for Safer Better Healthcare. services;
b) include basic
tools in relation to
safety, complaints,
competencies and
procedures around
prescribing; and
c) reflect a human
rights based and
person centred
approach.
4.2.44 Promote the participation Actively supporting DOH Relevant

of service users and their frontline services Departments
families, including those in through capacity and Agencies,
recovery, in local, regional building measures using C&V sectors,
and national decision- evidence based models DATFs, Networks
making structures and of participation in line of people who
networks in order to with best practice. use drugs and
facilitate their involvement alcohol, Networks
in the design, planning and of people who
development of services use services and/
and policies. Family Support
Networks

l Uptake of treatment in communities most affected by substance misuse (NDTRS).
l Changes in problem substance use in communities affected by deprivation (NDTRS).
l The number of deaths associated with drug use in marginalised communities (NDRDI).
CHAPTER 7 – Goal 5: Develop sound
and comprehensive evidence-informed
policies and actions
Objective 5.1. Support high quality monitoring, evaluation
and research to ensure evidence-informed policies and
practice
Monitoring
Ireland has good information on the substance misuse situation at a national level. Routine
monitoring provides the information on the nature, extent and consequences of substance
misuse needed to formulate evidence-informed policy, plan services and measure the
effectiveness of the responses to this problem. In fulfilment of both European and national
requirements Ireland’s monitoring system collects and analyses data on drug use in the
general and school-going population, treatment demand, high-risk drug use and on
consequences, such as infectious diseases, deaths and overdose.
Monitoring also provides information on harm reduction measures, and on prevention,

rehabilitation and other demand reduction interventions. Data is gathered through special
health surveillance systems, such as the National Drugs Treatment Reporting System (NDTRS),
regular population surveys or studies, published evaluations and analyses. The HSE’s data
collection systems provide information on infectious diseases, needle exchange and nonfatal
overdoses.
It is important that monitoring systems are aware of and in a position to exploit new sources
of data. Longitudinal studies, such as TILDA – The Irish Longitudinal Study on Ageing or
Growing up in Ireland, present opportunities to complement information from routine
monitoring with insights into substance use behaviour of particular population cohorts. The
analysis of trends over the past 10 years carried out to inform this strategy points out that most
of the information on vulnerable groups was obtained from single studies 11. In order to observe
trends we will need to explore ways of monitoring drug use and treatment uptake among the
populations at particular risk.
Evaluation
The strategy will largely be implemented through interventions delivered by statutory,
community and voluntary services. As evidence is one of the values underpinning the strategy
it will be expected that these interventions will be based on findings from the most recent
scientific research and that their implementation will be carefully studied. The effectiveness
of interventions will be established by measuring outcomes through a system of evaluation
built into programme plans. This is particularly important when the available evidence does
not clearly point to a particular course of action and innovative approaches are being followed.
Evaluation also includes reporting on the extent to which the implementation of an intervention
adheres to protocols and guidelines associated with the intervention.
Evidence-informed decision-making can be encouraged by working with services to improve
their evaluation processes and adopt an outcomes-focussed approach to implementing
interventions. DATFs, working with the HRB National Drugs Library, have identified a number of
outcomes that are relevant to the progress of service users in recovery 60. These outcomes are
organised by particular facets relevant to recovery such as personal circumstance and needs,
relationships and employment and skills. The framework also identifies validated instruments
that the taskforces can use to evaluate these outcomes. This project builds on the HRB’s
research dissemination activities that include specially commissioned reviews, a research
bulletin, an online library and web-based evidence resources.
Research
Research illuminates topics on which there is limited knowledge and tests the usefulness or
appropriateness of new approaches to delivering services and coordinating responses. This
work may involve primary research, secondary analysis of existing datasets, or synthesis
of existing research to ensure the highest quality evidence is available to practitioners and
policymakers. The HRB’s review of reviews 12 is an example of this synthesis and the strategy
will continue to build on this valuable resource. In order to derive maximum benefit careful
consideration should be given to implementing the findings of research and ensuring they
are central to the decision-making process in service delivery. All research projects, including
primary research and evidence syntheses should include a programme of dissemination and
knowledge-to-action activities that engage the stakeholders who will be implementing the
research findings.
While Ireland has good information at the national level, information on service needs and
on the implementation of interventions at the local level is less comprehensive. As the Rapid
Expert Review 10 noted, there are well managed and evaluated programmes throughout the
country. These could provide examples of good practice if there was a means of thoroughly
cataloguing them and making this knowledge available in a systematic way. This resource could
be very valuable in guiding decision-making and supporting innovative services who want to
use evidence in the selection, implementation and measurement of interventions. Findings
from individual programme evaluations can be aggregated and further analysed when there is
a shared approach to measuring interventions that have outcomes in common. In this way new
evidence can be created leading to refinement and further service improvement. So, monitoring,
evaluation, research and knowledge transfer are interdependent activities supporting good
practice, consistency and more effective services.
Adapting swiftly to rapidly changing conditions using reliable information will be an essential
attribute in the strategic response to substance misuse in the coming years. Developing this
capacity will require reliable, timely and comparable information. A robust, flexible and inclusive
system of monitoring, evaluation, knowledge transfer, and research can provide this resource.
Agency
5.1.45 Strengthen Ireland’s a) Continuing to monitor the drug HRB DOH,

drug monitoring situation and responses for national HSE,
system. and international purposes using HRB
EMCDDA protocols and existing
data collection systems, while
ensuring that Ireland can respond
to new data monitoring requests
arising from the National Committee
and the European Union during the
term of the Strategy;
b) Separating the organisation and DOH
budgeting of routine monitoring
from research projects;
c) Requesting all remaining hospital DOH
emergency departments include
the monitoring of attendances as
a result of alcohol and drugs use in
their electronic patient system; and
d) Developing a suitably integrated HSE
IT system which allows for the
effective sharing and collection
of appropriate outcome data.
5.1.46 Support evidence- a) Ensuring that public funding is DOH DES,

informed practice targeted at underlying need and DSP,
and service provision. supports the use of evidence- DCYA,
informed interventions and the HSE, IPS,
evaluation of pilot initiatives; PS, HRB
b) Designating the Health Research
Board as a central information hub
on evidence on the drugs situation
and responses to it;
c) Ensuring that mechanisms are in
place to communicate this evidence
in a timely manner to those working
in relevant healthcare settings,
including in acute and emergency
care; and
d) Developing collaborative
relationships with third level
institutions in the area of drugs and
alcohol so as to further government
funded research priorities.
5.1.47 Strengthen the Requiring all publicly funded drug and DOH, HSE,
National Drug alcohol services to complete the NDTRS DJE IPS, C&V
Treatment Reporting for all people who use services. sectors
System (NDTRS).
5.1.48 Develop a prioritised Harnessing existing data sources in DOH HSE,

programme of drug the drug and alcohol field in order to HRB
and alcohol-related enhance service delivery and inform
research on an policy and planning across government
annual basis. and the community and voluntary
sectors, and having done so, identify
deficits in research in the field to
enable the development of a prioritised
programme on an annual basis.
Agency
5.1.49 Improve knowledge Undertaking a study on rehabilitation DOH, HSE,

of rehabilitation outcomes, which takes into account the HRB UISCE,
outcomes. experience of service users and their (joint) NFSN,
families, and examines their outcomes C&V
across multiple domains, building on sectors
work already undertaken.

l General population survey completed and results published (Drugs Prevalence Survey).
l Opiate prevalence study completed and results published (DoH).
l Increase in the number of publicly funded drug and alcohol services completing NDTRS
forms (NDTRS).
l Annual Prioritised research programme agreed.
CHAPTER 8 – Strengthening the
performance of the strategy
Resources should be directed towards those interventions and strategies which are most likely
to lead to a reduction in problem substance use and a positive improvement in public health,
safety and wellbeing. The need for a way of measuring the overall effectiveness of the response
to the drug problem is therefore an important objective of public policy.
The level of progress achieved in delivering on the goals and related objectives and actions
of the strategy will be determined using performance indicators linked to each objective.
In addition, the key bodies responsible for delivering the strategic actions will be required
to report on progress on an annual basis to the Minister with responsibility for the National
Drugs Strategy. Monitoring of the progress in implementing the strategy will be supported
by a coordinated system of monitoring, evaluation and research as set out in in Goal 5.
A performance measurement system has been developed by independent external consultants,

Trutz Haase Social and Economic Consultants, to help Government assess whether the drugs
strategy is leading to an improvement in problem substance use across the country 61. This
measurement system goes further than an examination of progress in delivering on the actions
to support implementation of the strategy and their results, as set out in an annual report. The
performance measurement system is primarily concerned with the net effects of the strategy
at the population level, in particular, the effects on the health, wellbeing and quality of life of
people living in local and regional DATF areas.
Reducing Harm, Supporting Recovery has a number of population-based objectives and

it is only by measuring the population effects of interventions that these objectives can be
evaluated. The system takes into account the complex range of factors that can increase the
risk of problem substance use in an area, such as social problems, deprivation and levels of
social housing. When results at the local level are aggregated the success of the strategy as
a whole can be assessed.
The model which is at the core of the measurement framework makes predictions regarding
the level of problem drug use in a small area based on a number of social indicators describing
levels of deprivation, urbanity and social class. It then compares the predicted level of problem
substance use with the actual prevalence of problem substance use, on the basis of routine
monitoring systems, such as drug treatment data. If significant changes in problem drug or
alcohol use are found from one year to the next, or differences are observed between DATF
areas, there is an opportunity to analyse why such differences have emerged.
By identifying reasons for differences in outcomes, important and valuable information can
be obtained to support the successful implementation of the strategy. It will also facilitate
performance improvement in areas of the country where the strategy appears to be less
successful. This can also help DATFs improve their actions and interventions over time.
The performance measurement system incorporates a resource allocation model (RAM)

to enable funding to be allocated on a more equitable and rational basis, takes account of
underlying need in DATF areas and targets those communities which face a higher risk of
substance misuse. The RAM is currently based on the DATF global allocation, but it is intended
that over time the RAM will take into account the totality of public funding at the disposal
of the DATF partners. As information systems improve in the coming years, the performance
measurement system can draw upon more data sources to develop a more precise measure
of problem substance use.
The active participation and collective buy-in of all the key stakeholders will be extremely
important to the success of the system. Bringing forward measures to achieve positive change
and improve outcomes for individuals, families and communities affected by problem substance
use will require the commitment of all the key departments, agencies, DATFs and service
providers. It is therefore intended to develop an implementation plan to operationalise the
Performance Measurement Framework by 2020, in consultation with relevant stakeholders
and sectors. The implementation plan will aim to ensure that Task Forces have appropriate
arrangements in place for the selection and renewal of the Chair and members of the Task
Force and have proper procedures in place for addressing conflict of interest. It is envisaged
that these arrangements will be in line with the principles outlined in the Review of Drug Task
Forces (2011/12) 62.

Agency
6.1.50 Develop an a) Phasing in the introduction of a DOH HSE

implementation plan resource allocation model (RAM)
to operationalise to achieve a more equitable
a Performance distribution of resources across
Measurement System Task Force areas. This will involve
by 2020 which will monitoring and assessing the
support Reducing evidence from the operation of the
Harm, Supporting RAM on an annual basis;
Recovery, improve b) Identifying where significant
accountability changes in problem drug or alcohol
across the statutory, use are found from one year to the
community and next, or differences are observed
voluntary sectors between areas, and analysing why
and strengthen the such differences have emerged with
Drug and Alcohol a view to successfully implementing
Task Force model, the strategy and assisting
in consultation with DATFs improve their actions and
relevant stakeholders interventions over time;
and sectors.
c) Improving the alignment of Task
Force boundaries;
d) Ensuring that Task Forces have
appropriate arrangements in place
for the selection and renewal of
the Chair and members of the Task
Force and have proper procedures
in place for addressing conflict of
interest;
e) Building the capacity of DATFs
to participate in the Performance
Measurement System; and
f) Coordinating a cross-Departmental
approach at national and local level
to allow for the gathering of the
appropriate information and data
streams to feed into the ongoing
organic further development of
the Performance Measurement
Framework.
The coordination of the implementation of the 2009-2016 National Drugs Strategy was initially
led by a Minister/Office of the Minister for Drugs at the Department of Community, Rural and
Gaeltacht Affairs. The organisational structure of the current strategy is set out in the figure
below.
Figure 10: Organisational structure of the National Drugs Strategy 2009–2016
Government
Cabinet Committee on Social Inclusion, Children and Integration
Oversight Forum Minister/Office of the National Advisory

on Drugs Minister for Drugs Committee on Drugs
Drugs Advisory Group – replaced by National

Statutory Agencies
Coordinating Committee on DATFs
Drug and Alcohol Task Forces
The main role of the Office of the Minister for Drugs was to ensure national coordination of
the Strategy, support policy development, support the work of the Task Forces, support the
National Advisory Committee on Drugs (NACD), and support the community and voluntary
sector. Following a change of Government in 2011, the national drugs strategy function
was transferred to the Department of Health and the functions of the Office of the Minister
for Drugs, including the Drugs Advisory Group, were taken over by the Drugs Policy and
Programmes Unit within that Department.
A review of Drug Task Forces was undertaken in 2011/12 to assess the impact of Drug Task
Forces in order to ensure that they would continue to remain relevant, effective and fit for
purpose. The review also led to the commissioning of research into the development of a
Performance Measurement Framework for DATFs, which has been outlined above.
The Rapid Expert Review of the Strategy 10 noted that the current structures and
communication flows have evolved over time and appear rather complex and disjointed.
Their recommendations focused on the different functions needed to support the strategy
rather than on the specific bodies that are currently, or might in the future, be tasked with
these roles, emphasising:
l Leadership to provide drive, direction/prioritisation;
l Coordination at national and local level;
l Mobilisation of resources in terms of finances and personnel, including those
for whom drugs is not the primary focus of their work;
l Quality assurance and clinical governance involving national bodies working with
local areas to identify and evaluate innovative approaches and ensure standards are
maintained;
l Monitoring and evaluation of progress including appropriate performance indicators
linked to the specific objectives of the strategy;
l A structure to ensure that research is integrated within the strategy;
l Analysis and advice drawing out the implications of research findings for policy and
practice to be fed into discussions around direction and prioritisation at national level;
and
l Needs assessment, coordination and support for local implementation and a review
of Task Force boundaries in light of current needs.
A more streamlined structure is required to deliver on the key functions identified as important
by the Rapid Expert Review 10 and to optimise participation in the strategy, in a way which
avoids duplication and overlap.
National Oversight Committee

Accordingly, it is intended to establish a National Oversight Committee to give leadership and
direction to support implementation of the strategy. The Committee will meet on a quarterly
basis and be sponsored by the Minister of State with responsibility for the National Drugs
Strategy.
Membership
The Committee will have a cross-sector membership from the statutory, community and
voluntary sector, as well as clinical and academic expertise. Representation from the statutory
sector will be at the level of Assistant Secretary. It will be a matter for the Minister of State to
determine the final membership of the Committee, however, the suggested membership is set
out in the Table below.
Indicative Membership of the National Oversight Committee
Sector Body
Statutory Department of Health – Drugs Policy Unit
Statutory Department of Health – Health and Wellbeing Division
Statutory Health Service Executive
Statutory Health Research Board
Statutory Department of Justice and Equality
Statutory An Garda Síochána
Statutory Irish Prison Service
Statutory Probation Service
Statutory Revenue Customs Service
Statutory Department of Children and Youth Affairs
Statutory TUSLA
Statutory Department of Education and Skills
Statutory Department of Social Protection
Statutory Department of Housing, Planning and Local Government
Statutory Department of Transport, Tourism and Sport
Sector Body
Community Citywide Drug Crisis Campaign
Community Citywide Drug Crisis Campaign
Community National Family Support Network
Community Union for Improved Services Communication and Education
Voluntary Sector Voluntary Drug Treatment Network
Voluntary Sector Voluntary Drug Treatment Network
Task Force Local Drug and Alcohol Task Force Chairs Network
Task Force Local Drug and Alcohol Task Force Coordinators Network
Task Force Regional Drug and Alcohol Task Force Chairs Network
Task Force Regional Drug and Alcohol Task Force Coordinators Network
Clinical Expert To be appointed by Minister
Clinical Expert To be appointed by Minister
Academic Expert To be appointed by Minister
Terms of reference
The National Oversight Committee will have the following terms of reference:
(a) To give leadership, direction, prioritisation and mobilisation of resources to support
the implementation of the strategy;
(b) To measure performance in order to strengthen the delivery of drugs initiatives and
to improve the impact on the drug problem;
(c) To monitor the drugs situation and oversee the implementation of a prioritised
programme of research to address gaps in knowledge;
(d) To ensure that the lessons drawn from evidence and good practice inform the
development policy and initiatives to address the drug problem; and
(e) To convene Sub-Committees, as required, to support implementation of the strategy.
Operational Procedures
The National Oversight Committee will develop a prioritised work programme to support
the implementation of the strategy. The Committee will establish Sub-Committees, as it
sees fit, to address specific issues and to harness relevant expertise to enable it to deliver
on its key functions. Such committees will be required to report to the National Committee.
The number of Sub-Committees and their modus operandi will be a matter for the Chair
of the National Committee.
Standing Sub-Committee
A Standing Sub-Committee of the National Oversight Committee will be established to drive
the implementation of Reducing Harm, Supporting Recovery and promote coordination
between national, local and regional levels. The Sub-Committee will be chaired by a Senior
Official in the Department of Health. It will play a key role in ensuring that the statutory,
community and voluntary sectors, Drug and Alcohol Task Forces and other key stakeholders
are engaged in supporting the implementation of the strategy.
Membership
There will be a balance of representatives drawn from the statutory, community and voluntary
sectors. Membership will include, but not be limited to, representation from the networks of the
Chair and coordinators of the Local and Regional Drug and Alcohol Task Forces, the National
Family Support Network and UISCE. Statutory membership of the Standing Sub-Committee
will be at Principal Officer level or equivalent. Representation from the Department of Health
will include senior officials that are responsible for drug policy and alcohol policy.
Terms of Reference
The Standing Sub-Committee will have the following terms of reference:
(a) To drive implementation of Reducing Harm, Supporting Recovery at national, local
and regional level;
(b) To develop, implement and monitor responses to drug-related intimidation as
a matter of priority;
(c) To support and monitor the role of Drug and Alcohol Task Forces in coordinating
local and regional implementation of the National Drugs Strategy with a view to
strengthening the Task Force interagency model;
(d) To improve performance, promote good practice and build capacity to respond
to the drug problem in line with the evidence-base;
(e) To ensure good governance and accountability by all partners involved in the delivery
of the Strategy; and
(f) To report to the National Oversight Committee on progress in the implementation
of its work programme.
Operational Procedures
The Standing Sub-Committee will meet on a monthly basis, and agree an annual programme
of work to support implementation of the strategy. Drug-related intimidation will form part
of the early work programme agreed by the Standing Sub-Committee, in view of the need to
commence work on the issue.
Members of the Standing Sub-Committee will develop a liaison relationship with Task Forces
to support multi-directional coordination and communication between delivery bodies and
stakeholders at local, regional and national levels.
The standing Sub-Committee will develop capacity building measures to improve

implementation of the strategy, promote good practice, support the use of evidence and
strengthen engagement by the community and voluntary sectors in the national structures
of the strategy.
The Standing Sub-Committee will provide progress reports on the delivery of its work
programme for the quarterly meetings of the National Committee.
Resources for capacity building

The strategy contains a specific action to support and promote community participation in
all local, regional and national structures. A dedicated resource will be available to support
engagement in the national implementation structures, including the Standing Sub-Committee.
This resource will also be available to build capacity of the partners to implement the strategy
effectively, through disseminating models of best practice and innovation, evidence-based
approaches and by facilitating sharing and mutual learning.
The structures proposed by the Department of Health to support implementation of the

strategy’s objectives are illustrated in Figure 11.
Figure 11: Structures supporting implementation of Reducing Harm,
Supporting Recovery
Relevant Cabinet Committee
Minister of State for Health Promotion and the National Drugs Strategy
National Oversight Committee

Leadership / Direction / Prioritisation
Early Warning and Department of Health
Emerging Trends Drugs Policy Unit
Sub-Committee Analysis and Advice
Other Sub-Committees Standing Sub-Committee Health Research Board

As Required Implementation Support Monitoring and Research
Local and Regional Drug and Alcohol Task Force

Needs Assessment and Local Co-Ordination
Analysis and Advice

The Drugs Policy Unit of the Department of Health will be responsible for the provision of
objective and informed analysis and advice to the National Committee and its capacity to
deliver on this role will be strengthened under the new strategy. Its key functions will be:
(a) To analyse the implications of research findings for policy and design of initiatives
to tackle the drug problem;
(b) To provide advice to the National Committee on the commissioning of new research
and development of new data sources having regard to current information and
research deficits and advice and changing patterns of drug use and emerging trends;
and
(c) To provide a secretariat to the National Committee and the Standing Sub-Committee.
Monitoring, research and evaluation

The HRB will continue in its role as Irish national focal point to the EMCDDA. It will be the
central information hub for the collection, management and dissemination of data relating to
the drugs situation, consequences and responses. It will be responsible for reporting to the
EMCDDA on the five epidemiological indicators, namely:
(a) The prevalence and patterns of drug use among the general population;
(b) Prevalence and patterns of problem drug use;
(c) Demand for drug treatment;
(d) Drug-related deaths; and
(e) Drug-related infectious diseases.
As stated above, the National Oversight Committee will prioritise the research to be
undertaken to address gaps in knowledge. The HRB will manage the commissioning of
the research.
The Early Warning and Emerging Trends Sub-Committee plays a role in the Early Warning
System. Its original Terms of Reference were:
l To receive, share and monitor on behalf of the Department of Health, information from
National and EU sources on New Psychoactive Substances of concern in the context of
the Council Decision of 2005/387/JHA on information exchange, risk assessment and
control of new psychoactive substances;
l To receive, share and monitor on behalf of the Department of Health, information on
emerging trends and patterns in drug use particularly poly drug use and associated risks;
l To monitor the work on emerging trends being developed at EU level (EMCDDA
responsibility), to consider its implementation in Ireland;
l To monitor the reports to the Early Warning System on a quarterly basis about
emerging trends and New Psychoactive Substances, but more frequently if
circumstances warrant it;
l To examine new ways of getting sensitive information on changing patterns of drug use
and trends;
l To consider the implications of changing drug markets and distribution networks which
can impact on the popularity of certain psychoactive substances; and
l To review the risk assessment reports provided by the EMCDDA and determine their
relevance to the Irish situation and advise Government accordingly.
The role and terms of reference of the Early Warning and Emerging Trends Sub-Committee,
within the Early Warning System, will be reviewed under the strategy.
Needs assessment, local coordination and implementation

The current terms of reference of Drug and Alcohol Task Forces require them to coordinate
the implementation of the strategy in the context of the needs of the local/regional area,
implement the actions in the strategy where Task Forces have been assigned a role and
promote the implementation of evidence-based local/regional drug and alcohol strategies
and to exchange best practice. In 2012, their remit was extended to include alcohol, building
on their track record in engaging local communities. In the context of promoting an integrated
public health approach to substance misuse, which is defined as the harmful or hazardous
use of psychoactive substances including alcohol and illicit drugs, they will furnish an annual
report to the designated Minister with responsibility for the National Drugs Strategy. The
general arrangements for reporting will be determined by the standing Sub-Committee
for implementation support.
The Task Forces are the key bodies to provide needs assessment, local coordination and
implementation and the performance measurement framework will provide Task Forces with
the information required to more effectively fulfil these functions. The Minister for Health
Promotion and the National Drugs Strategy will convene meetings with the DATFs as required.
Boundary issues
Local and Regional DATFs have been effective in promoting cooperation between the statutory,
community and voluntary sectors. They have also provided a targeted response to drugs
issues as they affect people on the ground. It has been suggested, in the past, that the large
number of Local DATFs creates administrative difficulties and unnecessary complications in
the relationship with other service providers. These agencies are often required to interact
with multiple Local DATFs within a given catchment area. The RAM within the Performance
Measurement Framework provides a rational basis for addressing the boundary issues that
arose for historical reasons following the establishment of Regional DATFs, in and around the
Dublin areas.
CHAPTER 9 – Conclusion
This strategy was drawn up by a Steering Committee, established in December 2015, by the
Minister with special responsibility for the National Drugs Strategy.
The process of developing the strategy involved an intensive process of public consultation, a
rapid expert review, a review of reviews of interventions to tackle the drug problem, an analysis
of drug trends in the past decade and a series of engagements with key stakeholders to identify
gaps in the current response to the drug problem. The independence of the process was
assured by an independent chair, who guided the Steering Committee in its work.
The core objective of the new strategy is to provide an integrated public health response to
substance misuse, which recognises that substance misuse includes the harmful or hazardous
use of psychoactive substances, including illegal drugs, alcohol and prescription medicines. It
underlines the importance of a health-led person-centred approach to tackling the problem of
substance misuse. It contains a series of actions which are to be delivered over the next four
years (2017-2020). These are set out in Chapter 10 of this document. Key partners are identified
to drive implementation of the actions, while recognising there will be many actions of a cross-
sectoral nature requiring input from a range of stakeholders.
It aims to achieve a whole-of-government response to problem substance misuse by

highlighting other policy frameworks and strategies which will contribute towards addressing
the risk factors for substance misuse in our society, and makes suggestions for achieving
greater synergies with these strategies and policies into the future. A list of the relevant
strategies and policy frameworks are provided in Appendix 2 of the document. The strategy is
a dynamic process, that will be monitored through the key national, local and regional stuctures
charged with ensuring the implementation of the strategy. There will be flexibility to introduce
new measures after four years to address issues which emerge during that period.
CHAPTER 10 – Strategic action plan for
the period 2017-2020
Agency
1.1.1 Ensure that the a) Developing an initiative to DOH HSE, DATFs

commitment to an ensure that the commitment
integrated public to an integrated public health
health approach to approach to drugs and alcohol
drugs and alcohol is delivered as a key priority;
is delivered as a key and
priority. b) Promoting the use of evidence
based approaches to mobilising
community action on alcohol.
1.1.2 Improve the delivery a) Organising a yearly national HRB HSE, DOH,
of substance use forum on evidence-based and DES, DCYA
education across all effective practice on drug and
sectors, including alcohol education; and
youth services, b) Developing a guidance
services for people document to ensure substance
using substances use education is delivered
and other relevant in accordance with quality
sectors. standards.
1.2.3 Support the SPHE a) Promoting continued effective DES,

programme. communications between DATFs
local schools and Drug and (Joint)
Alcohol Task Forces given
the importance placed on the
continued building of strong
school community links; and
b) Ensuring that all SPHE teachers, DES
guidance counsellors and
Home School Community
Liaison co-ordinators can avail
of continuing professional
development.
1.2.4 Promote a health In line with the Action Plan for DES DOH/HSE
promotion Education
approach to a) Commencing and rolling out
addressing a national programme to
substance misuse. support the implementation
of the Wellbeing Guidelines to
all primary and post-primary
schools; and
b) Developing Wellbeing
Guidelines for Centres of
Education and Training.
Agency
1.2.5 Improve supports a) Providing a continuum of DES HSE

for young people support including a Student
at risk of early Support Plan as appropriate,
substance use. for young people who are
encountering difficulty in
mainstream education;
b) Providing access to timely DES
appropriate interventions HSE
such as resilience-building
TUSLA
programmes, and/or
counselling, educational (Joint
assessments and/or clinical Leads)
psychological assessments,
as appropriate;
c) Implementing School TUSLA DES
Attendance Strategies in
line with TUSLA’s guidance;
d) Prioritising initiatives under DES TUSLA
the new DEIS programme to
address early school leaving;
and
e) Providing supports including DHPLG
homework clubs, additional
tuition, career guidance/
counselling support, community
awareness of drugs programme
and youth work in collaboration
with schools and other youth
programmes/schemes.
1.2.6 Ensure those Reviewing Senior Cycle programmes DES

who do not seem and Vocational Pathways in senior
to thrive in a cycle with a view to recommending
traditional academic areas for development.
setting complete
their education.
1.2.7 Facilitate increased Engaging with property owners DES

use of school and school authorities to facilitate
buildings, where increased use of school buildings,
feasible, for where feasible, for afterschool care
afterschool care and out of hours use to support
and out of hours local communities.
use to support local
communities.
1.2.8 Improve services Developing a new scheme to DOH DCYA, HSE,

for young people provide targeted, appropriate and DATF.
at risk of substance effective services for young people
misuse in socially at risk of substance misuse, focused
and economically on socially and economically
disadvantaged disadvantaged communities.
communities.
Agency
1.3.9 Mitigate the risk a) Developing and adopting HSE, NFSN

and reduce the evidence-based family and TUSLA C&V sectors
impact of parental parenting skills programmes (Joint
substance misuse for services engaging with Leads)
on babies and high risk families impacted by
young children. problematic substance use;
b) Building awareness of the
hidden harm of parental
substance misuse with the aim
of increasing responsiveness to
affected children;
c) Developing protocols between
addiction services, maternity
services and children’s health
and social care services that will
facilitate a coordinated response
to the needs of children affected
by parental substance misuse;
and
d) Ensuring adult substance use
services identify clients who
have dependent children and
contribute actively to meeting
their needs either directly or
through referral to or liaison
with other appropriate services,
including those in the non-
statutory sector.
1.3.10 Strengthen the Considering how best to provide TUSLA

life-skills of young necessary once-off supports for
people leaving Care Leavers to gain practical life-
care in order to long skills in line with Action 69 of
reduce their risk the Ryan Report in order to reduce
of developing their risk of developing substance
substance use use problems.
problems.
1.3.11 Strengthen early Establishing a working group to HSE DOH

harm reduction examine the evidence in relation
responses to to early harm reduction responses,
current and such as drug testing, amnesty bins
emerging trends and media campaigns, to current
and patterns of and emerging trends including the
drug use. use of new psychoactive substances
and image and performance
enhancing drugs and other high risk
behaviours, including chemsex.
2.1.12 Strengthen the a) Developing a competency HSE

implementation of framework on key working, care
the National Drugs planning and case management;
Rehabilitation and
Framework. b) Extending the training
programme on the key
processes of the National Drugs
Agency
2.1.13 Expand the a) Identifying and addressing gaps HSE C&V sectors,
availability and in provision within Tier 1, 2, 3 DATFs
geographical and 4 services;
spread of relevant b) Increasing the number of
quality drug and treatment episodes provided
alcohol services and across the range of services
improve the range available, including:
of services available,
l Low Threshold;
based on identified
need. l Stabilisation;
l Detoxification;
l Rehabilitation;
l Step-down;
l After-Care;
c) Strengthening the capacity of
services to address complex
needs.
2.1.14 Improve the Examining potential mechanisms to HSE DOH

availability of increase access to OSTs such as the
Opioid Substitution expansion of GP prescribing, nurse-
Treatments (OSTs). led prescribing and the provision of
OSTs in community-based settings
and homeless services.
2.1.15 Enhance the quality Implementing the HSE National HSE DOH
and safety of care Clinical Guidelines on OST and
in the delivery of reviewing in line with National
Opioid Substitution Clinical Effectiveness Committee
Treatment (OST). processes.
2.1.16 Improve relapse Developing and broadening the HSE C&V sectors,
prevention and range of peer-led, mutual aid and UISCE, NFSN
aftercare services. family support programmes in
accordance with best practice.
2.1.17 Further strengthen a) Developing addiction specific TUSLA HSE, NFSN

services to support bereavement support
families affected by programmes and support
substance misuse. the provision of respite for
family members;
b) Supporting families with
non-violent resistance training
to address child to parent
violence; and
c) Supporting those caring for
children/young people in their
family as a result of substance
misuse to access relevant
information, supports and
services.
Agency
2.1.18 Help individuals a) Monitoring and supporting DSP HSE

affected by the implementation of Other
substance misuse to the Department of Social relevant
build their recovery Protection’s Programme Departments
capital. Framework for Community & Agencies,
Employment Drug C&V sectors
Rehabilitation Schemes, based
on an integrated inter-agency
approach; and
b) Utilising SICAP to improve the DHPLG
life chances and opportunities
of those who are marginalised
in society, living in poverty
or in unemployment through
community development
approaches, targeted supports
and interagency collaboration.
2.1.19 Increase the range Establishing a Working Group to: DOH HSE, DSP,
of progression a) Examine the range of IPS, Other
options for progression options for relevant
recovering drug those exiting treatment, prison, Departments
users and develop a Community Employment & Agencies
new programme of schemes including key skills
supported care and training and community
employment. participation with a view to
developing a new programme
of supported care and
employment; and
b) Identify and remedy the
barriers to accessing the
range of educational, personal
development, training and
employment opportunities
and supports, including gender
specific barriers and the lack
of childcare provision, for
those in recovery.
Agency
2.1.20 Expand addiction a) Strenghtening links between DOH HSE

services for maternity services and addiction
pregnant and services;
postnatal women. b) Quantifying the need
for additional residential
placements for pregnant and
postnatal women who need in-
patient treatment for addiction
to drugs and/or alcohol across
the country;
c) Developing services to meet
that need ensuring that
such facilities support the
development of the mother-
baby relationship;
d) Providing dedicated support
for pregnant women with
alcohol dependency, including
examining the need to expand
the role of the Drug Liaison
Midwife (DLM) in this regard.
Any such expansion will likely
generate a need to further
increase the number of such
midwives;
e) Resourcing the National Women
and Infants Health Programme
(NWIHP) to provide drug liaison
midwives and specialist medical
social workers in all maternity
networks;
f) Supporting maternity hospitals/
units to strengthen their
methods of detecting alcohol
abuse and supporting women to
reduce their intake; and
g) Engaging the NWIHP to
develop a consistent approach
to informing women about the
risks of alcohol consumption
during pregnancy.
2.1.21 Respond to the a) Increasing the range of wrap- HSE DOH, DATFs
needs of women around community and
who are using drugs residential services equipped to
and/or alcohol in a meet the needs of women who
harmful manner. are using drugs and/or alcohol
in a harmful manner, including
those with children and those
who are pregnant; and
b) Developing interventions to
address gender and cultural
specific risk factors for not
taking up treatment.
Agency
2.1.22 Expand the range, a) Identifying and addressing gaps HSE, C&V sectors,
availability and in child and adolescent service TUSLA DATFs
geographical provision;
spread of problem b) Developing multi-disciplinary
drug and alcohol child and adolescent teams; and
services for those
c) Developing better interagency
under the age of 18.
cooperation between problem
substance use and child and
family services.
2.1.23 Improve the Examining the need for the HSE C&V sectors,
response to the development of specialist services DATFs
needs of older to meet the needs of older people
people with long with long term substance use issues.
term substance use
issues.
2.1.24 Improve outcomes a) Supporting the new Mental HSE DOH, IPS,
for people with Health Clinical Programme to C&V sectors
co-morbid severe address dual diagnosis; and
mental illness and b) Developing joint protocols
substance misuse between mental health
problems. services and drug and alcohol
services with the objective of
undertaking an assessment
with integrated care planning
in line with the National Drug
Agency
2.1.25 In line with a) Increasing the number of HSE C&V sectors

Rebuilding Ireland, detoxification, stabilisation and
improve the rehabilitation beds;
range of problem b) Providing additional/enhanced HSE LAs, C&V
substance use assessment, key working, care sectors
services and planning and case management.
rehabilitation This entails person-centred
supports for people holistic care planning, including
with high support identifying and building social
needs who are and recovery capital;
homeless.
c) Ensuring in-reach support HSE LAs, C&V
during treatment and sectors
rehabilitation to prevent
homelessness on discharge
to ensure that housing and
supports are in place;
d) Ensuring resourcing and DOH HSE, LAs,
enhanced cooperation DHPLG C&V sectors
arrangements between non-
governmental service providers
and State organisations,
involved in the delivery of
addiction treatment and
housing services, so that the
drug rehabilitation pathway is
linked to sustainable supported
housing-led/housing first
tenancy arrangements; and
e) Developing the provision of LAs, HSE DHPLG, DOH,
gender and culturally specific C&V sectors
step down services, particularly
housing, for women and
their children progressing
from residential rehabilitation
treatment who are at risk of
discharge into homelessness.
2.1.26 Intervene early a) Providing training to enable IPS, PS AGS, HSE

with at risk groups the delivery of screening, brief
in criminal justice intervention and onward referral
settings. in line with national screening
and brief intervention protocols
for problem substance use;
b) Further develop the range IPS, PS
of service specific problem
substance use interventions
in line with best international
practice; and
c) Determining the prevalence IPS HSE
of NPS use in prison settings
with a view to developing
specific training for staff and
appropriate interventions.
Agency
2.1.27 Improve the a) Fostering engagement with HSE C&V sectors

capacity of services representatives of these
to accommodate communities, and/or services
the needs of working with them, as
people who use appropriate;
drugs and alcohol b) Considering the need for
from specific specialist referral pathways for
communities specific groups who may not
including otherwise attend traditional
the Traveller addiction services (i.e. those
community; who engage in chemsex);
the lesbian,
c) Providing anti-racism, cultural
gay, bisexual,
competency and equality
transgender and
training to service providers;
intersex community;
and
new communities;
sex workers and d) Ensuring all services engage
homeless people. in ethnic equality monitoring
by reporting on the nationality,
ethnicity and cultural
background of service users for
the NDTRS and treat related
disclosures with sensitivity.
2.2.28 Continue to expand a) Expanding needle exchange HSE C&V sectors

Harm Reduction programmes;
Initiatives focused b) Increasing the availability
on people who of screening and treatment
inject drugs. for blood borne viruses and
communicable diseases; and
c) Increasing the uptake of
Hepatitis C treatment.
2.2.29 Provide enhanced Establishing a pilot supervised HSE DOH, UISCE,

clinical support to injecting facility and evaluating Dublin City
people who inject the effectiveness of the initiative. Council,
drugs and mitigate Relevant
the issue of public Local
injecting. Authorities,
C&V sectors
Agency
2.2.30 Continue to target a) Finalising HSE-led Overdose HSE DOH

a reduction in drug- Prevention Strategy with
related deaths and a particular focus on
non-fatal overdoses. implementing preventative
measures to target high-risk
cohorts of the drug-using
population and known overdose
risk periods;
b) Expanding the availability of HSE C&V sectors,
Naloxone to people who use UISCE, NFSN,
drugs, their peers, and family DATFs
members;
c) Developing synergies between DOH
Reducing Harm, Supporting
Recovery and other relevant
strategies and frameworks
in particular “Connecting for
Life” whose primary aim is
to reduce suicide rates in the
whole population and amongst
specified priority groups; and
d) Providing suicide prevention HSE HSE
training to staff working with DOH
young people in the area of
alcohol and substance use, in
line with Connecting for Life.
3.1.31 Keep legislation up- Keep legislation under review, DOH, DJE AGS,
to-date to deal with against the background of national, Revenue’s
emerging trends in EU and broader international Customs
the drugs situation. experiences and best practice, Service,
to deal with emerging trends, HPRA
including:
a) new synthetic substances;
b) new or changed uses of
psychoactive substances; and
c) the evolving situation with
regard to drug precursors and
the surface web and dark net
drug markets.
3.1.32 Reduce rates of Implementing the measures relating DTTAS

driving under the to the testing of drivers for drugs
influence of drugs. and alcohol contained in the Road
Traffic Act 2016.
3.1.33 Reduce drug Implementing the recommendations DJE

offending behaviour of the Final Report of the Working
and promote Group on a Strategic Review of
rehabilitation. Penal Policy of July 2014 relating to
drug-offending behaviours.
3.1.34 Map the future a) Carrying out an independent DJE

direction and evaluation of the Drug
objectives of the Treatment Court; and
Drug Treatment b) Continuing to support the
Court. operation of the Drug Treatment
Court, having regard to the
recommendations made in the
2013 review 53, pending the
outcome of the evaluation.
Agency
3.1.35 Consider the Establishing a Working Group to DOH, DJE AGS, Relevant
approaches taken in consider the approaches taken in (Joint) Departments
other jurisdictions other jurisdictions to the possession and agencies
to the possession of small quantities of drugs for
of small quantities personal use in light of the Report
of drugs for of the Joint Committee on Justice,
personal use with Defence and Equality on a Harm
a view to making Reducing and Rehabilitative
recommendations approach to possession of small
on policy options to amounts of illegal drugs to examine:
the relevant Minister a) the current legislative
within 12 months. regime that applies to simple
possession offences in this
jurisdiction and the rationale
underpinning this approach,
and any evidence of its
effectiveness;
b) the approaches and experiences
in other jurisdictions to dealing
with simple possession offences;
c) the advantages and
disadvantages, as well as the
potential impact and outcomes
of any alternative approaches
to the current system for the
individual, the family and
society, as well as for the
criminal justice system and the
health system;
d) the identification of the scope
of any legislative changes
necessary to introduce
alternative options to criminal
sanctions for those offences;
e) a cost benefit analysis of
alternative approaches to
criminal sanctions for simple
possession offences; and
f) make recommendations to the
relevant Minister within twelve
months.
3.2.36 Support the role of Investing in capacity building AGS, DOH, DJE,
law enforcement measures to support the role Revenue HPRA
authorities in of law enforcement authorities Custom’s
monitoring in monitoring drug markets, in Service
drug markets, in particular new drug markets, surface
particular new drug web and darknet drug markets.
markets, surface
web and darknet
drug markets.
3.2.37 Consider the case Subject to the completion of the AGS

for the use of Garda examination of Community
Community Impact Impact Statements, bringing
Statements within forward recommendations on their
the Criminal Justice implementation.
System in Ireland.
Agency
3.3.38 Strengthen the a) Continuing to develop systems DOH HSE, HRB,

response to the to monitor changing drug FSI, State
illegal drug market, trends in line with the EU Early Lab, MBRS
including the Warning System; AGS
changing nature of
new psychoactive b) Completing the development HSE DOH, HSE,
substances. of the HSE public alert system DJE
for adverse events due to
drugs and commencing
implementation;
c) Supporting government DPER,
funded laboratories, tasked DTTAS
with analysis of drugs of abuse,
to engage in novel analytical
development work, in relation
to psychoactive drugs but
especially new psychoactive
substances (licit or illicit), while
continuing to fulfil their core
functions;
d) Providing funding in the capital DJE
expenditure programme for the
construction of a purpose built
new laboratory for Forensic
Science Ireland with €6m
prioritised to commence the
project immediately; and
e) Strengthen the legal robustness
of Presumptive Drug Testing
(PDT) to contribute to the
timely prosecution of Section
(3) drug-related offences.
4.1.39 Support and Supporting and promoting DOH Community

promote community participation in all local, Sector, LAs,
community regional and national structures. DHPLG,
participation in all DATFs
local, regional and
national structures.
4.1.40 Measure the Developing and piloting a C&V

impact of drug- Community Impact Assessment Tool sectors
related crime in order to measure the impact of
and wider public drug-related crime and wider public
nuisance issues on nuisance issues on communities.
communities.
4.1.41 Enhance the Building on the achievements of DJE,

relationship Local Policing Fora in providing an DHPLG,
between an Garda effective mechanism for building AGS
Síochána and and maintaining relationships
local communities between an Garda Síochána and the
in relation to the local communities, in particular in
impact of the drugs relation to the impact of the drugs
trade. trade.
Agency
4.1.42 Strengthen the An Garda Síochána and the National AGS,

effectiveness of Family Support Network will each NFSN
the Drug-Related carry out its own evaluation of the
Intimidation Drug-Related Intimidation Reporting
Reporting Programme to strengthen its
Programme. effectiveness and, if appropriate,
develop measures to raise public
awareness of the programme.
4.2.43 Build capacity Requiring the delivery of services DOH HSE

within drug and within a Quality Assurance
alcohol services to Framework, which will
develop a patient a) standardise services;
safety approach
b) include basic tools in relation
in line with the
to safety, complaints,
HIQA National
competencies and procedures
Standards for Safer
around prescribing; and
Better Healthcare.
c) reflect a human rights based
and person centred approach.
4.2.44 Promote the Actively supporting frontline DOH Relevant

participation of services through capacity building Departments
service users and measures using evidence based and Agencies,
their families, models of participation in line with C&V sectors,
including those best practice. DATFs,
in recovery, in Networks of
local, regional and people who
national decision- use drugs
making structures and alcohol,
and networks in Networks of
order to facilitate people who
their involvement in use services
the design, planning and/Family
and development Support
of services and Networks
policies.
Agency
5.1.45 Strengthen Ireland’s a) Continuing to monitor the HRB DOH, HSE,

drug monitoring drug situation and responses HRB
system. for national and international
purposes using EMCDDA
protocols and existing data
collection systems, while
ensuring that Ireland can
respond to new data monitoring
requests arising from the
National Committee and the
European Union during the term
of the Strategy;
b) Separating the organisation and DOH
budgeting of routine monitoring
from research projects;
c) Requesting all remaining DOH
hospital emergency
departments include the
monitoring of attendances as
a result of alcohol and drugs
use in their electronic patient
system; and
d) Developing a suitably integrated HSE
IT system which allows for the
effective sharing and collection
of appropriate outcome data.
5.1.46 Support evidence- a) Ensuring that public funding is DOH DES, DSP,
informed practice targeted at underlying need and DCYA, HSE,
and service supports the use of evidence- IPS, PS, HRB
provision. informed interventions and the
evaluation of pilot initiatives;
b) Designating the Health Research
Board as a central information
hub on evidence on the drugs
situation and responses to it;
c) Ensuring that mechanisms are
in place to communicate this
evidence in a timely manner
to those working in relevant
healthcare settings, including in
acute and emergency care; and
d) Developing collaborative
relationships with third level
institutions in the area of drugs
and alcohol so as to further
government funded research
priorities.
5.1.47 Strengthen Requiring all publicly funded drug DOH, DJE HSE, IPS, C&V
the National and alcohol services to complete sectors
Drug Treatment the NDTRS for all people who use
Reporting System services.
(NDTRS).
Agency
5.1.48 Develop a Harnessing existing data sources in DOH HSE, HRB

prioritised the drug and alcohol field in order
programme of drug to enhance service delivery and
and alcohol-related inform policy and planning across
research on an government and the community and
annual basis. voluntary sectors, and having done
so, identify deficits in research in the
field to enable the development of a
prioritised programme on an annual
basis.
5.1.49 Improve knowledge Undertaking a study on DOH, HSE, UISCE,

of rehabilitation rehabilitation outcomes, which HRB NFSN, C&V
outcomes. takes into account the experience (joint) sectors
of service users and their families,
and examines their outcomes across
multiple domains, building on work
already undertaken.
Agency
6.1.50 Develop an a) Phasing in the introduction DOH HSE

implementation of a resource allocation
plan to model (RAM) to achieve a
operationalise more equitable distribution
a Performance of resources across Task
Measurement Force areas. This will involve
System by 2020 monitoring and assessing the
which will support evidence from the operation of
Reducing Harm, the RAM on an annual basis;
Supporting b) Identifying where significant
Recovery, improve changes in problem drug or
accountability alcohol use are found from one
across the statutory, year to the next, or differences
community and are observed between areas,
voluntary sectors and analysing why such
and strengthen the differences have emerged
Drug and Alcohol with a view to successfully
Task Force model, implementing the strategy and
in consultation assisting DATFs improve their
with relevant actions and interventions over
stakeholders and time;
sectors.
c) Improving the alignment of Task
Force boundaries;
d) Ensuring that Task Forces have
appropriate arrangements in
place for the selection and
renewal of the Chair and
members of the Task Force
and have proper procedures in
place for addressing conflict of
interest;
e) Building the capacity of
DATFs to participate in the
Performance Measurement
System; and
f) Coordinating a cross-
Departmental approach at
national and local level to
allow for the gathering of
the appropriate information
and data streams to feed
into the ongoing organic
further development of the
Performance Measurement
Framework.
APPENDIX 1 – Membership of the Steering
Committee on the National Drugs Strategy
Sector Body Number of
Representatives
Statutory Sector Department of Health 3
Statutory Sector Health Service Executive 2
Statutory Sector Department of Justice & Equality 1
Statutory Sector An Garda Síochána 1
Statutory Sector Department of Education & Skills 1
Statutory Sector Department of Housing, Planning 1

and Local Government
Statutory Sector Department of Children & Youth Affairs 1
Statutory Sector Department of Social Protection 1
Statutory Sector Health Research Board 1
Community Sector Community Sector – represented by CityWide 2

Drugs Crisis Campaign
Community Sector National Family Support Network 1
Voluntary Sector Voluntary Sector – represented by the 2

Voluntary Drug Treatment Network
Cross-sector Task Force Local Drug and Alcohol Task Force Chairs 1
network Network
Cross-sector Task Force Regional Drug and Alcohol Task Force Chairs 1
network Network
Cross-sector committee National Advisory Committee on Drugs and 1

Alcohol
Representative group UISCE 1
APPENDIX 2 – List of relevant inter-
connected strategies and policies
l National Substance Misuse Strategy, 2012
l “Creating a better future together”: National Maternity Strategy 2016-2026
l Healthy Ireland – a framework for improved Health and Wellbeing, 2013-2025
l Better Outcomes, Brighter Futures, 2014-2020
l Updated National Action Plan for Social Inclusion, 2015-2017
l National Sexual Health Strategy 2015-2020
l Connecting for Life: Ireland’s National Strategy to Reduce Suicide 2015-2020
l National Traveller and Roma Inclusion Strategy (2016-2020)
l National Women’s Strategy 2017-2020
l Rebuilding Ireland – action plan for housing and homelessness
l Homeless Strategy National Implementation Plan
l Mental Health Strategy A Vision for Change
l The Joint Irish Prison Service and Probation Service Strategic Plan 2015-2017
l Irish Prison Service 2011, Health Care Standards
l An Garda Síochána’s 2016 National, Regional and Divisional Policing Plans
l Garda Síochána 2017 Crime Prevention and Reduction Strategy
l Garda Síochána Strategy Statement 2016-2018
l An Garda Síochána’s Modernisation and Renewal Programme 2016-2021
l Tobacco Free Ireland, 2013 and Tobacco Free Ireland Action Plan, 2014-2025
l Irish Sports Council’s National Anti-Doping Programme
l EU Drugs Strategy and action plans, 2013-2020
Glossary of Terms
AA Alcoholics Anonymous
CAMHS Child and Adolescent Mental Health Service
CE Community Employment scheme
CIS Community Impact Statements
CBT Cognitive Behavioural Therapy
DTF Drugs Task Forces
DATF Drug and Alcohol Task Forces
DEIS “Delivering Equality of Opportunity in Schools” programme
DES Department of Education and Skills
DHPLG Department of Housing, Planning and Local Government
DSP Department of Social Protection
DTTAS Department of Transport, Tourism and Sport
DOH Department of Health
DJE Department of Justice and Equality
EMCDDA European Monitoring Centre for Drugs and Drug Addiction
ESRI Economic and Social Research Institute
ESPAD European School Survey Project on Alcohol and Other Drugs
EU European Union
FSI Forensic Science Ireland
GNDOCB Garda National Drugs and Organised Crime Bureau
GP General Practitioner
HBSC Health Behaviour in School-Aged Children survey
HIQA Health Information and Quality Authority
HPSC Health Protection Surveillance Centre
HRB Health Research Board
HSE Health Service Executive
HCV Hepatitis C Virus
ICP Integrated Care Pathway
IPED Image and Performance Enhancing Drugs
IPS Irish Prison Service
LDATF Local Drug and Alcohol Task Force
LDTF Local Drugs Task Force
LGBTI Lesbian, Gay, Bisexual, Transgender and Intersex
LCDC Local Community Development Committee
MAT Mandatory Alcohol Testing
MIT Mandatory Intoxication Testing
MBRS Medical Bureau of Road Safety
NACDA National Advisory Committee on Drugs and Alcohol
NACD National Advisory Committee on Drugs
NCC National Coordinating Committee for Drugs and Alcohol Task Forces
NDRDI National Drug-Related Deaths Index
NDRF National Drugs Rehabilitation Framework
NDRIC National Drug Rehabilitation Implementation Committee
NDTRS National Drug Treatment Reporting System
NFSN National Family Support Network
NPS New Psychoactive Substance
NWIHP National Women & Infants Health Programme
OFD Oversight Forum on Drugs
OST Opioid Substitution Treatment
PPN Public Participation Network
PWID People who inject drugs
RDATF Regional Drug and Alcohol Task Force
RAM Resource Allocation Model
RDTF Regional Drugs Task Force
SIF Supervised Injecting Facilities
SICAP Social Inclusion and Community Activation Programme
SPHE Social, Personal and Health Education
SWOT Strength, Weakness, Opportunities and Threats analysis
TILDA The Irish Longitudinal Study on Ageing
TUSLA TUSLA Child and Family agency
UN United Nations
UNGASS United Nations General Assembly Special Session (on drugs)
VFMPR Value for Money Policy Review
YoDA Youth Drug and Alcohol Service
YPFSF Young People’s Facilities and Services Fund
References
1. Department of Tourism, Sport and Recreation. Building on experience: National
Drugs Strategy 2001–2008. Dublin: Stationery Office, 2001. Available at
http://www.drugsandalcohol.ie/5187/
2. Department of Community, Rural and Gaeltacht Affairs,. National Drugs Strategy

(interim) 2009–2016. Dublin: Department of Community, Rural and Gaeltacht Affairs,
2009. Available at http://www.drugsandalcohol.ie/12388/
3. Department of Health. Healthy Ireland – a framework for improved health

and wellbeing 2013–2025. Dublin: Department of Health, 2013. Available at
4. Clarke A, Eustace A. Evaluation of the HSE naloxone demonstration project Dublin:

Health Service Executive, 2016. Available at http://www.drugsandalcohol.ie/26037/
5. Department of Justice. Criminal Justice (Psychoactive Substances) Act 2010, 2010.

Available at http://www.drugsandalcohol.ie/27439/
6. National Advisory Committee on Drugs and Alcohol. Prevalence of drug use

and gambling in Ireland & drug use in Northern Ireland. Bulletin 1. Dublin:
National Advisory Committee on Drugs and Alcohol, 2016. Available at
7. Hay G, Jaddoa A, Oysten J, et al. Estimating the prevalence of problematic opiate

use in Ireland using indirect statistical methods. Dublin, Forthcoming. Available at
8. Health Research Board. National Drug-Related Deaths Index 2004 to 2014 data. Dublin:
Health Research Board, 2016. Available at http://www.drugsandalcohol.ie/26299/
9. Department of Health. Steering Group report on a national substance misuse strategy.

Dublin: Department of Health, 2012. Available at http://www.drugsandalcohol.ie/16908/
10. Griffiths P, Strang J, Singleton N. Rapid expert review of the National Drugs
Strategy 2009-2016 Dublin: Department of Health, 2016. Available at
11. John Moores University. The drugs situation in Ireland: an overview of trends from
2005 to 2015. Liverpool: Centre for Public Health Liverpool John Moores University,
12. Bates G, Public Health Institute Liverpool John Moores University. The drugs
situation in Ireland: an overview of trends from 2005 to 2015, 2017. Available at
13. European Monitoring Centre for Drugs and Drug Addiction. European drug report 2017
trends and developments. Luxembourg: Publications Office of the European Union,
14. Long J, Mongan D. Alcohol consumption in Ireland 2013: analysis of a national
alcohol diary survey. Dublin: Health Research Board, 2014. Available at
15. Department of Health. General Scheme of the Public Health Alcohol Bill 2015. Dublin:
Department of Health, 2015. Available at http://www.drugsandalcohol.ie/23383/
16. Department of Children and Youth Affairs. Better outcomes brighter futures.
The national policy framework for children & young people 2014–2020. Dublin:
Stationery Office, 2014. Available at http://www.drugsandalcohol.ie/21773/
17. Department of Education and Skills. Action plan for education
2017. Dublin: Department of Education and Skills, 2017. Available at
18. Department of Children and Youth Affairs. Value for money and policy review of
the youth programmes that target disadvantaged young people. Dublin: Government
Publications, 2014. Available at http://www.drugsandalcohol.ie/23242/
19. Tickner N. Early leavers – What next? Dublin: Department of Education, 2013.
20. Haase T, Pratschke J. Risk and protection factors for substance use among
young people: a comparative study of early school leavers and school attending
students. Dublin: National Advisory Committee on Drugs, 2010. Available
at www.drugsandalcohol.ie/14100/
21. Smyth E. Educational research and policy reform: unpacking the relationship.
European Conference on Educational Research 2016, Leading education: the
distinct contributions of educational research and researchers. Dublin, 2016. Available
at http://www.eera-ecer.de/ecer-programmes/conference/21/contribution/39139/
22. Horgan J. Parental substance misuse: addressing its impact on children: a review
of the literature. Dublin: National Advisory Committee on Drugs, 2011. Available at
23. Horgan J. Parental substance misuse: addressing its impact on children: Key messages
and recommendations from a review of the literature. Dublin: National Advisory
Committee on Drugs, 2011. Available at http://www.drugsandalcohol.ie/16115/
24. Ryan S, Commission to Inquire into Child Abuse. Report of the Commission to inquire
into child abuse (The Ryan Report). Dublin: Stationery Office, 2009. Available at
25. Bingham T, O’Driscoll C, De Barra G. National student drug survey 2015. Dublin:
National Student Drug survey, 2015. Available at http://www.drugsandalcohol.ie/24807/
26. O’Donnell Kate, Fitzgerald Margaret, Barrett Peter et al MISI 2015 – Findings from the
men who have sex with men internet survey. Dublin: Health Protection Surveillance
Centre, 2016. Available at http://www.drugsandalcohol.ie/25656/
27. Jennings Ciaran J, Patten Emer, Kennedy Mark, et al. Examining the profile and
perspectives of individuals attending harm reduction services who are users of
performance and image enhancing drugs. Dublin: Merchants Quay Ireland, 2014.
28. Bryant-Jefferies R. Models of care for drug service provision. Oxford: Radcliffe
Publishing Ltd 2004.
29. Doyle J, Ivanovic J. National drugs rehabilitation framework document. Dublin:

Health Service Executive, 2010. Available at www.drugsandalcohol.ie/13502/
30. Health Research Board. Drug treatment in Ireland 2009-2015. Dublin: Health
Research Board, 2017. Available at http://www.drugsandalcohol.ie/27023/
31. Health Service Executive. Health service performance report October-
December 2016. Dublin: Health Service Executive, 2017. Available at
32. Cox G, Whitaker T. Drug use, sex work and the risk environment in Dublin. Dublin:
National Advisory Committee on Drugs, Stationery Officer 2009. Available at
33. Munton T, Wedlock E, Gomersall A. The role of social and human capital in recovery
from drug and alcohol addiction. Dublin: Health Research Board, 2014. Available at
34. Sumnall H, Brotherhood A. Social reintegration and employment: evidence and
interventions for drug users in treatment. Luxembourg: Publications Office of the
European Union, 2012. Available at http://www.drugsandalcohol.ie/18596
35. Barry S, Kearney A, Daly S, et al. The Coombe Women’s Hospital: study of alcohol,
smoking & illicit drug use 1987–2005. Dublin: Coombe Women’s Hospital, 2007.
36. Popova S, Lange S, Probst C, et al. Estimation of national, regional, and global
prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic
review and meta-analysis. The Lancet Global Health 2017;5(3):e290-e99. Available at
37. Department of Health. Creating a better future together. National Maternity
Strategy 2016-2026. Dublin: Department of Health, 2016. Available at
38. James P, Smyth BP, Apantaku-Olajide T. Substance use and psychiatric disorders
in Irish adolescents: a cross-sectional study of patients attending substance abuse
treatment service. Mental Health and Substance Use 2013;6(2):124-32.Available at
39. Health Service Executive. Clinical guidelines for opioid substitution treatment. Dublin:
Health Service Executive, 2016. Available at http://www.drugsandalcohol.ie/26573/
40. O’Reilly F, Barror S, Hannigan A, et al. Homelessness: an unhealthy state.
Health status, risk behaviours and service utilisation among homeless
people in two Irish cities Dublin: The Partnership for Health Equality, 2015.
41. Department of the Taoiseach. Rebuilding Ireland: action plan for housing
and homelessness. Dublin: Department of the Taoiseach, 2016. Available at
42. Health Research Board. Irish National Focal Point to the European Monitoring Centre
for Drugs and Drug Addiction. Ireland: national report for 2016 – prison. Dublin: Health
Research Board, 2017. Available at http://www.drugsandalcohol.ie/25265/
43. Clarke A, Eustace A. Review of drug and alcohol treatment services for adult offenders
in prison and in the community. Dublin: Probation Service and Irish Prison Service,
44. Higgins A, Doyle L, Downes C, et al. The LGBTI Ireland report: national study
of the mental health and wellbeing of lesbian, gay, bisexual, transgender
and intersex people in Ireland Dublin: GLEN and BelongTo, 2016. Available at
45. Health Research Board. Irish National Focal Point to the European Monitoring
Centre for Drugs and Drug Addiction. Ireland: national report for 2016 –
harms and harm reduction. Dublin: Health Research Board, 2017. Available
at http://www.drugsandalcohol.ie/25259/
46. Department of Health. Misuse of Drugs (Supervised Injecting Facilities) Act 2017. 2017,
47. European Monitoring Centre for Drugs and Drug Addiction. European drug report
2016: trends and developments. Luxembourg: Publications Office of the European
Union, 2016. Available at http://www.drugsandalcohol.ie/25579/
48. Health Service Executive. National service plan 2017 Dublin: Health Service Executive,
49. Department of Health, Health Service Executive, National Office for Suicide Prevention.
Connecting for life. Ireland’s National Strategy to reduce suicide 2015-2020 Dublin:
Department of Health, 2015. Available at http://www.drugsandalcohol.ie/24167/
50. United Nations Office on Drugs and Crime. Outcomes document of the 2016 United
Nations General Assembly Special Session on the World Drug Problem New York,
19-21 April 2016. Our joint commitment to effectively addressing and countering
the world drug problem. Vienna: United Nations Office on Drugs and Crime, 2016.
Available at http://www.drugsandalcohol.ie/27442
51. Road Safety Authority. Anti drug driving. Campaign tackles drug driving and promotes
awareness of new Preliminary Drug Testing. Available from: http://www.rsa.ie/en/RSA/
Road-Safety/Campaigns/Current-road-safety-campaigns/Anti-Drug-Driving/ accessed
June, 13 2017.
52. Strategic Review Group on Penal Policy. Strategic review of penal policy. Dublin:
Department of Justice and Equality, 2014. Available at http://www.drugsandalcohol.
ie/22657/
53. Department of Justice and Equality. Report of the review of the operation of the drug
treatment court. Unpublished. Dublin: Department of Justice and Equality, 2013.
54. An Garda Síochána. An Garda Síochána statement strategy July 2016-2018 Dublin:
An Garda Síochána, 2016. Available at http://www.drugsandalcohol.ie/27305/
55. An Garda Síochána. An Garda Síochána modernisation and renewal

programme 2016-2021. Dublin: An Garda Síochána, 2015. Available at
56. Garda Inspectorate. Report of the Garda Síochána Inspectorate. Crime investigation.
Dublin: Garda Inspectorate, 2014. Available at http://www.drugsandalcohol.ie/22967/
57. Murphy L, Farragher L, Keane M, et al. Drug-related intimidation. The Irish situation
and international responses: an evidence review. Dublin: Health Research Board, 2017.
58. An Garda Síochána. Crime prevention & reduction strategy. Putting prevention first.
Dublin: An Garda Síochána, 2017. Available at http://www.drugsandalcohol.ie/27147/
59. Health Information and Quality Authority. National standards for safer better
healthcare. Dublin: Health Information and Quality Authority, 2012. Available at
60. Ni Ogain E, Hodgson L. Drug and alcohol recovery outcomes framework. London:
Catch Impact, 2017. Available at http://www.drugsandalcohol.ie/27096/
61. Haase T, Pratschke J. A performance measurement framework for drug and alcohol
task forces. Dublin: Trutz Haase – Social & Economic Consultants, 2017. Available at
www.drugsandalcohol.ie/27488
62. Department of Health. Report on the review of drugs task forces and the national
structures under which they operate. Dublin: Department of Health, 2012. Available
at http://www.drugsandalcohol.ie/19054/
63. RPS Group Limited. Public consultation to inform the new national drugs
strategy – public consultation report: RPS Group Limited, 2017. Available at
64. Department of Transport, Tourism and Sport. Road Traffic Act 2010, 2010.
65. Department of Justice and Equality. Criminal Justice (Spent Convictions and Certain
Disclosures) Act 2016, 2016. Available at http://www.drugsandalcohol.ie/27503/
Department of Health
T: +353 (0) 1 6354000
health.gov.ie

Reducing Harm Supporting Recovery 2017 2025

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Reducing Harm Supporting Recovery 2017 2025

Uploaded by

Copyright:

Available Formats

Reducing Harm,

Foreword by Minister of State for Health Promotion and the

Acknowledgements by Chair of Steering Committee 6

CHAPTER 2 – Vision, Values and Goals 16

CHAPTER 3 – Goal 1: Promote and protect health and wellbeing 19

Objective 1.1: Promote healthier lifestyles within society 21

Objective 1.2: Prevent use of drugs and alcohol at a young age 22

Objective 1.3: Develop harm reduction interventions targeting at risk groups 28

Performance indicators related to Goal 1 32

Objective 2.2: Reduce harm amongst high risk drug users 49

Performance Indicators related to Goal 2 53

CHAPTER 5 – Goal 3: Address the harms of drug markets and reduce

Objective 3.1: Provide a comprehensive and responsive misuse of drugs

Objective 3.2: Implement effective law enforcement and supply

Objective 3.3: Develop effective monitoring and responses to evolving

Performance indicators related to Goal 3 62

Objective 4.1: Strengthen the resilience of communities and build their

Performance Indicators related to Goal 4 68

CHAPTER 7 – Goal 5: Develop sound and comprehensive evidence-informed

Objective 5.1. Support high quality monitoring, evaluation and research

Performance Indicators related to Goal 5 72

CHAPTER 8 – Strengthening the performance of the strategy 73

CHAPTER 10 – Strategic action plan for the period 2017-2020 82

APPENDIX 1 – Membership of the Steering Committee on the

APPENDIX 2 – List of relevant inter-connected strategies

Glossary of Terms 100

Reducing Harm, Supporting Recovery represents a whole-of-government response

Reducing Harm, Supporting Recovery emphasises a health-led response to drug

Leo Varadkar, T.D.

Catherine Byrne, T.D.

Chapter 8 outlines the arrangements required to support the effective implementation of

To realise this vision, five strategic goals have been identified:

Figure 1: Summary of background information provided by respondents

Source: Public Consultation Report.63

Perceptions of the National Drugs Strategy

The primary research questions for this review were:

Rapid Expert Review

France Denmark Finland Ireland

Source: (EMCDDA, 2017)

Males Females All Drinkers

The strategic objectives of the Bill are to:

Objective 1.1: Promote healthier lifestyles within society

Prevention is a collaborative effort, which involves a range of stakeholders, including parents

1.1.1 Ensure that the a) Developing an initiative to ensure DOH HSE,

1.1.2 Improve the delivery of a) Organising a yearly national HRB HSE,

Objective 1.2: Prevent use of drugs and alcohol at a

Any illegal drug Cannabis Ecstasy Cocaine

Figure 5: Last month prevalence of cannabis use (%)

15-34 age group 35-64 age group

Early school leaving and substance use

Providing a continuum of support and ensuring access to resilience building programmes,

1.2.3 Support the SPHE a) Promoting continued effective DES,

1.2.5 Improve supports for a) Providing a continuum of support DES HSE

1.2.6 Ensure those who do Reviewing Senior Cycle programmes DES

1.2.7 Facilitate increased use Engaging with property owners DES

Objective 1.3: Develop harm reduction interventions

Children leaving care

Risks associated with belonging to particular groups or sub-populations

1.3.10 Strengthen the life-skills Considering how best to provide TUSLA

1.3.11 Strengthen early harm Establishing a working group to HSE DOH

Objective 2.1: To attain better health and social outcomes

Tier 2 includes harm reduction support, which may be provided by a pharmacy or in a

In Tier 3 treatment and rehabilitation services provide specialist interventions in a range of

Acknowledgements by Chair of Steering Committee 6

CHAPTER 2 – Vision, Values and Goals 16

CHAPTER 3 – Goal 1: Promote and protect health and wellbeing 19

Objective 1.1: Promote healthier lifestyles within society 21

Objective 1.2: Prevent use of drugs and alcohol at a young age 22

Objective 1.3: Develop harm reduction interventions targeting at risk groups 28

Performance indicators related to Goal 1 32

Objective 2.2: Reduce harm amongst high risk drug users 49

Performance Indicators related to Goal 2 53

Performance indicators related to Goal 3 62

Performance Indicators related to Goal 4 68

Performance Indicators related to Goal 5 72

CHAPTER 8 – Strengthening the performance of the strategy 73

CHAPTER 10 – Strategic action plan for the period 2017-2020 82

Glossary of Terms 100